Provider Demographics
NPI:1497521363
Name:KIDD, HOLLY ANN X
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:ANN
Last Name:KIDD
Suffix:X
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 1:404 W STRUB RD
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-5778
Mailing Address - Country:US
Mailing Address - Phone:419-357-7668
Mailing Address - Fax:
Practice Address - Street 1:404 W STRUB RD
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-5778
Practice Address - Country:US
Practice Address - Phone:419-975-2428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-30
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide