Provider Demographics
NPI:1508529835
Name:KIDWELL, MORGAN BRIANNA (PA)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:BRIANNA
Last Name:KIDWELL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:MORGAN
Other - Middle Name:BRIANNA
Other - Last Name:ANDREWS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:407 S 11TH ST
Mailing Address - Street 2:
Mailing Address - City:LAKE WALES
Mailing Address - State:FL
Mailing Address - Zip Code:33853-4243
Mailing Address - Country:US
Mailing Address - Phone:863-419-8366
Mailing Address - Fax:
Practice Address - Street 1:407 S 11TH ST
Practice Address - Street 2:
Practice Address - City:LAKE WALES
Practice Address - State:FL
Practice Address - Zip Code:33853-4243
Practice Address - Country:US
Practice Address - Phone:863-419-8366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-13
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL363A00000X
FLPA9115368363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant