Individual
MRS. MARY ANNE KIDWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
5352 LINTON BLVD, DELRAY BEACH, FL 33484-6514
(561) 498-4440
Mailing address
5190 LAS VERDES CIR APT 212, DELRAY BEACH, FL 33484-8048
(702) 332-4191
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
1537
SD
363A00000X
Physician Assistant
PA839
NV
363AM0700X
Medical Physician Assistant
Primary
9118662
FL
363AM0700X
Medical Physician Assistant
PA839
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1537
STATE LICENSE
SD
05
—
1649365289
—
NV
01
—
9118662
STATE LICENSE
FL
01
—
PA839
STATE LICENSE
NV
Enumeration date
10/03/2006
Last updated
01/24/2025
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