Individual
STEPHANIE S KIDD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
10101 ERNST RD STE 1200, ROANOKE, IN 46783-9711
(260) 234-5400
(260) 235-5410
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
02005696A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001525777
ANTHEM PTAN
IN
05
—
300028933
—
IN
Enumeration date
06/20/2017
Last updated
01/09/2025
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