Provider Demographics
NPI:1437309564
Name:KIDDE, HEATHER BROWN (CNM)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:BROWN
Last Name:KIDDE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:MS
Other - First Name:HEATHER
Other - Middle Name:LAUREN
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:104 PORTER DRIVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05753
Mailing Address - Country:US
Mailing Address - Phone:802-388-5682
Mailing Address - Fax:802-388-5692
Practice Address - Street 1:20 ARMORY LANE
Practice Address - Street 2:
Practice Address - City:VERGENNES
Practice Address - State:VT
Practice Address - Zip Code:05491
Practice Address - Country:US
Practice Address - Phone:802-388-5682
Practice Address - Fax:802-388-5692
Is Sole Proprietor?:No
Enumeration Date:2008-09-25
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101-0041875367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1015569Medicaid
VT1015569Medicaid