Provider Demographics
NPI:1093842262
Name:KIDWELL, ROSEMARY LYNN (RN)
Entity Type:Individual
Prefix:MS
First Name:ROSEMARY
Middle Name:LYNN
Last Name:KIDWELL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7721 BORUFF RD
Mailing Address - Street 2:
Mailing Address - City:CORRYTON
Mailing Address - State:TN
Mailing Address - Zip Code:37721
Mailing Address - Country:US
Mailing Address - Phone:865-688-5678
Mailing Address - Fax:
Practice Address - Street 1:1522 CHEROKEE TRAIL
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920
Practice Address - Country:US
Practice Address - Phone:865-549-5240
Practice Address - Fax:865-549-5344
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000052816163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse