Individual
JUSTIN L KIDD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1633 MEDICAL CENTER PT, COLORADO SPRINGS, CO 80907-5700
(719) 473-6155
(719) 473-3688
Mailing address
PO BOX 35380, LAS VEGAS, NV 89133-5380
(702) 579-3253
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA.0003632
CO
363AS0400X
Surgical Physician Assistant
003902
GA
363AS0400X
Surgical Physician Assistant
Primary
PA-003632
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38527057
—
CO
Enumeration date
10/20/2005
Last updated
04/22/2026
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