Individual
RICKY L KIDMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
51 11TH AVENUE, AYNOR, SC 29511-3249
(843) 358-3700
(843) 358-3707
Mailing address
300 SINGLETON RIDGE RD, ATTENTION PNS CREDENTIALING, CONWAY, SC 29526-9142
(843) 234-6946
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
1094
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1140PA
—
SC
Enumeration date
04/12/2006
Last updated
08/21/2025
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