Provider Demographics
NPI:1588643019
Name:KIDDER, KATHLEEN M (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:M
Last Name:KIDDER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:276 NEWPORT RD
Mailing Address - Street 2:THE GALLERY, SUITE 107
Mailing Address - City:NEW LONDON
Mailing Address - State:NH
Mailing Address - Zip Code:03257-5468
Mailing Address - Country:US
Mailing Address - Phone:603-526-4144
Mailing Address - Fax:603-526-4167
Practice Address - Street 1:276 NEWPORT RD
Practice Address - Street 2:THE GALLERY, SUITE 107
Practice Address - City:NEW LONDON
Practice Address - State:NH
Practice Address - Zip Code:03257-5468
Practice Address - Country:US
Practice Address - Phone:603-526-4144
Practice Address - Fax:603-526-4167
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3992393OtherCIGNA
NHS78734OtherHARVARD PILGRIM
NH30009297Medicaid
NH30009297Medicaid