Provider Demographics
NPI:1093209744
Name:LIDGETT, KRISTEN ALYCE
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:ALYCE
Last Name:LIDGETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9908 BRIMHALL RD STE 101
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93312-3179
Mailing Address - Country:US
Mailing Address - Phone:661-324-4747
Mailing Address - Fax:661-321-3280
Practice Address - Street 1:9908 BRIMHALL RD STE 101
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93312-3179
Practice Address - Country:US
Practice Address - Phone:661-324-4747
Practice Address - Fax:661-321-4749
Is Sole Proprietor?:No
Enumeration Date:2018-06-17
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95009379363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95-2707101Medicaid