Individual
CRYSTAL MCKIDDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A
Contact information
Practice address
14662 N US HIGHWAY 25 E, CORBIN, KY 40701-6425
(606) 526-9005
(606) 526-8606
Mailing address
82 EDGEWOOD DR, WILLIAMSBURG, KY 40769-1559
(423) 215-2002
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
2075
TN
363AM0700X
Medical Physician Assistant
Primary
PA1887
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1527317
—
TN
Enumeration date
01/06/2012
Last updated
03/13/2024
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