Provider Demographics
NPI:1609833656
Name:KIDD, JASON S (CRNA)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:S
Last Name:KIDD
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:330 ARKANSAS ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-1335
Mailing Address - Country:US
Mailing Address - Phone:785-842-7026
Mailing Address - Fax:785-842-7088
Practice Address - Street 1:330 ARKANSAS ST
Practice Address - Street 2:SUITE 210
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-1335
Practice Address - Country:US
Practice Address - Phone:785-842-7026
Practice Address - Fax:785-842-7088
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS55494367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered