Provider Demographics
NPI:1033528591
Name:KIDDLE, MATTHEW (PA)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:KIDDLE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:907 GEORGIANA ST
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-3911
Mailing Address - Country:US
Mailing Address - Phone:360-565-0999
Mailing Address - Fax:360-457-1599
Practice Address - Street 1:907 GEORGIANA ST
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-3911
Practice Address - Country:US
Practice Address - Phone:360-565-0999
Practice Address - Fax:360-457-1599
Is Sole Proprietor?:No
Enumeration Date:2014-08-10
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60615596363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant