Individual
MYSTII ELLEN KIDD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PNP
Contact information
Practice address
4001 W 15TH ST STE 350, PLANO, TX 75093-5863
(972) 596-2131
(682) 303-2031
Mailing address
PO BOX 733784, DALLAS, TX 75373-3784
(682) 885-6483
(682) 885-3113
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
AP107293
TX
Other
Enumeration date
08/24/2011
Last updated
07/25/2022
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