Provider Demographics
NPI:1881480283
Name:KIDDER, JONATHAN LEE
Entity type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:LEE
Last Name:KIDDER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1398 TOWNSHIP ROAD 1106
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44805-9705
Mailing Address - Country:US
Mailing Address - Phone:757-739-2634
Mailing Address - Fax:
Practice Address - Street 1:1398 TOWNSHIP ROAD 1106
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OH
Practice Address - Zip Code:44805-9705
Practice Address - Country:US
Practice Address - Phone:757-739-2634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-15
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH161110164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse