Provider Demographics
NPI:1346934916
Name:KIDD, AMANDA SUMMER
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:SUMMER
Last Name:KIDD
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 1:3220 S KNOXVILLE AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-4441
Mailing Address - Country:US
Mailing Address - Phone:918-229-0421
Mailing Address - Fax:
Practice Address - Street 1:3220 S KNOXVILLE AVE APT 4
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-4441
Practice Address - Country:US
Practice Address - Phone:918-229-0421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist