Individual
DEBRA KAY KIDD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
7 INDEPENDENCE PT STE 300, GREENVILLE, SC 29615-4569
(864) 522-3700
(864) 522-3705
Mailing address
300 E MCBEE AVE FL 4, GREENVILLE, SC 29601-2842
(864) 522-8603
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
1462
SC
367500000X
Certified Registered Nurse Anesthetist
48340
WV
367500000X
Certified Registered Nurse Anesthetist
COA.09620-NA
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000573847
ANTHEM
OH
01
—
000000644238
ANTHEM
OH
05
—
260315900
—
WV
05
—
2603159000
—
WV
05
—
2884080
—
OH
05
—
AN0931
—
SC
01
—
P00703818
RRMCR
OH
Enumeration date
11/16/2006
Last updated
12/28/2021
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