Provider Demographics
NPI:1962820134
Name:KIDDER, RANDEE (APRN-FNP-C)
Entity Type:Individual
Prefix:
First Name:RANDEE
Middle Name:
Last Name:KIDDER
Suffix:
Gender:F
Credentials:APRN-FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8490 PICARDY AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-3733
Mailing Address - Country:US
Mailing Address - Phone:225-237-1790
Mailing Address - Fax:
Practice Address - Street 1:8585 PICARDY AVE STE 317
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-3749
Practice Address - Country:US
Practice Address - Phone:225-387-7077
Practice Address - Fax:225-442-5088
Is Sole Proprietor?:No
Enumeration Date:2014-04-03
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP07732363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2359541Medicaid
LAAP07732OtherNURSE PRACTIONER LICENSE
LA347445YJ6VMedicare PIN