Provider Demographics
NPI:1245425834
Name:KIDD, KENNETH WAYNE
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:WAYNE
Last Name:KIDD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1148 W 103RD ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-4511
Mailing Address - Country:US
Mailing Address - Phone:816-942-4300
Mailing Address - Fax:816-942-4302
Practice Address - Street 1:1148 W 103RD ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-4511
Practice Address - Country:US
Practice Address - Phone:816-942-4300
Practice Address - Fax:816-942-4302
Is Sole Proprietor?:No
Enumeration Date:2007-09-07
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007008453174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist