Provider Demographics
NPI:1982243937
Name:KIDD, TONNESHA (PMHNP-BC)
Entity Type:Individual
Prefix:MS
First Name:TONNESHA
Middle Name:
Last Name:KIDD
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 33113
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08629-3113
Mailing Address - Country:US
Mailing Address - Phone:800-931-8026
Mailing Address - Fax:609-631-5130
Practice Address - Street 1:1676 N OLDEN AVE BLDG 1
Practice Address - Street 2:
Practice Address - City:EWING
Practice Address - State:NJ
Practice Address - Zip Code:08638-3210
Practice Address - Country:US
Practice Address - Phone:180-093-1802
Practice Address - Fax:609-631-5130
Is Sole Proprietor?:No
Enumeration Date:2019-12-22
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01067200363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health