Individual
SHANNON M KIDD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
401 MATTHEW ST, MARIETTA, OH 45750-1635
(740) 374-9990
(740) 374-9993
Mailing address
2139 AUBURN AVE, CINCINNATI, OH 45219-2906
(740) 374-4500
(740) 374-5887
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
60137
WV
367500000X
Certified Registered Nurse Anesthetist
Primary
COA.11504.NA
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000662146
ANTHEM
OH
01
—
000000666683
ANTHEM
OH
05
—
2937764
—
OH
05
—
3810014829
—
WV
01
—
P01058722
RAILROAD MEDICARE
OH
Enumeration date
11/29/2007
Last updated
03/06/2017
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