Provider Demographics
NPI:1780992289
Name:WILLIAMS KIDD, JAMESETTA
Entity type:Individual
Prefix:
First Name:JAMESETTA
Middle Name:
Last Name:WILLIAMS 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 1:1514 BODART DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-2406
Mailing Address - Country:US
Mailing Address - Phone:832-797-6589
Mailing Address - Fax:281-583-8537
Practice Address - Street 1:324 GENTRY ST
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77373-8316
Practice Address - Country:US
Practice Address - Phone:832-797-6589
Practice Address - Fax:281-583-8527
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-17
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes211D00000XPodiatric Medicine & Surgery Service ProvidersAssistant, Podiatric