Individual
MR. KEITH L KIDD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
FNP-BC
Contact information
Practice address
9026 HIWASSEE ST NE, CHARLESTON, TN 37310-5305
(423) 665-3666
(423) 584-6747
Mailing address
PO BOX 15, CHARLESTON, TN 37310-0015
(423) 665-3666
(423) 584-6747
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
13254
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02684136
AMERIGROUP
TN
01
—
3476201
CIGNA
—
05
—
Q007277
—
TN
Enumeration date
03/17/2008
Last updated
10/29/2021
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