Mr Keith L Kidd, FNP-BC | |
9026 Hiwassee St Ne, Charleston, TN 37310-5305 | |
(423) 665-3666 | |
(423) 584-6747 |
Full Name | Mr Keith L Kidd |
---|---|
Gender | Male |
Speciality | Nurse Practitioner - Family |
Location | 9026 Hiwassee St Ne, Charleston, Tennessee |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1811168941 | NPI | - | NPPES |
Q007277 | Medicaid | TN | |
02684136 | Other | TN | AMERIGROUP |
3476201 | Other | CIGNA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
363LF0000X | Nurse Practitioner - Family | 13254 (Tennessee) | Primary |
Entity Name | Preferred Family Medical Care Llc |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1699188029 PECOS PAC ID: 6800013608 Enrollment ID: O20140818001619 |
Mailing Address | Practice Location Address |
---|---|
Mr Keith L Kidd, FNP-BC Po Box 15, Charleston, TN 37310-0015 Ph: (423) 665-3666 | Mr Keith L Kidd, FNP-BC 9026 Hiwassee St Ne, Charleston, TN 37310-5305 Ph: (423) 665-3666 |
Mr. Danny Ray Nelson, NP-C Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 424 Wylou Dr Nw, Charleston, TN 37310 Phone: 423-715-7224 Fax: 423-614-3033 | |
Michelle Lynn White, FNP-BC Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 9026 Hiwassee Street, Ne, Us-11, Charleston, TN 37310 Phone: 423-665-3666 |