Provider Demographics
NPI:1710928528
Name:KIDNER, MARIA C (DNP, FNP-BC, FAANP)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:C
Last Name:KIDNER
Suffix:
Gender:F
Credentials:DNP, FNP-BC, FAANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 82298
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70598-2298
Mailing Address - Country:US
Mailing Address - Phone:337-288-4895
Mailing Address - Fax:307-206-1133
Practice Address - Street 1:535 E MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:LANDER
Practice Address - State:WY
Practice Address - Zip Code:82520-3410
Practice Address - Country:US
Practice Address - Phone:307-206-1171
Practice Address - Fax:307-206-1133
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY13621.0252363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY117923300Medicaid
WY20667Medicare ID - Type Unspecified
WY117923300Medicaid