Provider Demographics
NPI:1437429560
Name:KIDD-WATKINS, KIMBERLY NINA (RN, MSN)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:NINA
Last Name:KIDD-WATKINS
Suffix:
Gender:F
Credentials:RN, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1730 THEALE WAY
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MD
Mailing Address - Zip Code:21076-1899
Mailing Address - Country:US
Mailing Address - Phone:443-336-9283
Mailing Address - Fax:
Practice Address - Street 1:1730 THEALE WAY
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:MD
Practice Address - Zip Code:21076-1899
Practice Address - Country:US
Practice Address - Phone:443-336-9283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-05
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR099642163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse