Provider Demographics
NPI:1871194621
Name:KIDD, CHRISTINE MARIE
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:MARIE
Last Name:KIDD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 S. STALLWORTH
Mailing Address - Street 2:
Mailing Address - City:ROSEBUD
Mailing Address - State:TX
Mailing Address - Zip Code:76570
Mailing Address - Country:US
Mailing Address - Phone:254-291-0002
Mailing Address - Fax:
Practice Address - Street 1:412 S. STALLWORTH
Practice Address - Street 2:
Practice Address - City:ROSEBUD
Practice Address - State:TX
Practice Address - Zip Code:76570
Practice Address - Country:US
Practice Address - Phone:254-291-0002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX694614163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse