Provider Demographics
NPI:1164783221
Name:KIDD, ALERO A (RN,BSN,LLB)
Entity Type:Individual
Prefix:
First Name:ALERO
Middle Name:A
Last Name:KIDD
Suffix:
Gender:F
Credentials:RN,BSN,LLB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2920 N DESHONG RD
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-3908
Mailing Address - Country:US
Mailing Address - Phone:610-348-9337
Mailing Address - Fax:
Practice Address - Street 1:2920 N DESHONG RD
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30087-3908
Practice Address - Country:US
Practice Address - Phone:610-348-9337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN213036163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health