Provider Demographics
NPI:1629667613
Name:KIDD, SHAYNA SPEARMAN (FNP)
Entity Type:Individual
Prefix:MRS
First Name:SHAYNA
Middle Name:SPEARMAN
Last Name:KIDD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 BOONSHILL RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37334-6415
Mailing Address - Country:US
Mailing Address - Phone:256-655-4145
Mailing Address - Fax:
Practice Address - Street 1:12935 HIGHWAY 231 431 N
Practice Address - Street 2:
Practice Address - City:HAZEL GREEN
Practice Address - State:AL
Practice Address - Zip Code:35750-8631
Practice Address - Country:US
Practice Address - Phone:256-828-6766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-13
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-126779363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily