Provider Demographics
NPI:1184003501
Name:KIDDER, DENISE KING (FNP, APRN, MSN/ED)
Entity Type:Individual
Prefix:MS
First Name:DENISE
Middle Name:KING
Last Name:KIDDER
Suffix:
Gender:F
Credentials:FNP, APRN, MSN/ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6140 E COLUMBIA ST
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715-9133
Mailing Address - Country:US
Mailing Address - Phone:812-475-1948
Mailing Address - Fax:812-401-1267
Practice Address - Street 1:6140 E COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-9133
Practice Address - Country:US
Practice Address - Phone:812-475-1948
Practice Address - Fax:812-401-1267
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-19
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX736145363LF0000X
IN71006308A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN234140005Medicare PIN