Individual
ETHAN SHANE KIDD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
6128 E 38TH ST, TULSA, OK 74135-5832
(918) 779-7144
(918) 663-0203
Mailing address
6128 E 38TH ST, TULSA, OK 74135-5832
(918) 779-7144
(918) 663-0203
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
04/16/2024
Last updated
04/16/2024
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