Individual
MR. GREGORY THOMAS KIDWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ARNP
Contact information
Practice address
4800 COLLEGE ST SE, LACEY, WA 98503-4389
(360) 486-2900
Mailing address
PO BOX 3360, PORTLAND, OR 97208-3360
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
AP60897119
WA
Other
Enumeration date
10/14/2016
Last updated
08/26/2019
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