Provider Demographics
NPI:1770749624
Name:KIDD, TIFFANY LEIGH (DNP,PNP-BC)
Entity type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:LEIGH
Last Name:KIDD
Suffix:
Gender:F
Credentials:DNP,PNP-BC
Other - Prefix:
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Mailing Address - Street 1:1901 TATE SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501-1109
Mailing Address - Country:US
Mailing Address - Phone:434-200-3656
Mailing Address - Fax:434-200-3650
Practice Address - Street 1:1901 TATE SPRINGS RD
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-1109
Practice Address - Country:US
Practice Address - Phone:434-200-3656
Practice Address - Fax:434-200-3650
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-30
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0024167929363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics