Provider Demographics
NPI:1518356377
Name:KIDD, LOREN MIKALE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:LOREN
Middle Name:MIKALE
Last Name:KIDD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9405 US HIGHWAY 23 S STE 2
Mailing Address - Street 2:
Mailing Address - City:STANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41659-9048
Mailing Address - Country:US
Mailing Address - Phone:606-899-2273
Mailing Address - Fax:606-202-7252
Practice Address - Street 1:9405 US HIGHWAY 23 S STE 2
Practice Address - Street 2:
Practice Address - City:STANVILLE
Practice Address - State:KY
Practice Address - Zip Code:41659-9048
Practice Address - Country:US
Practice Address - Phone:606-899-2273
Practice Address - Fax:606-202-7252
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-16
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3009172363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily