Kidd, Justin L

Kidd, Justin L is an individual health care provider with primary practice located at 1725 E Boulder St Ste 101, Colorado Springs CO 80909-5768. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Surgical, which is considered as his primary health care specialty. Kidd, Justin L can be contacted via phone (719) 365-9916.

Contact Information

Primary practice address
1725 E Boulder St Ste 101 Colorado Springs CO 80909-5768
Phone: (719) 365-9916
Fax: (719) 365-9969
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Surgical 363AS0400X 003902 Georgia
Physician Assistants & Advanced Practice Nursing Providers / Surgical 363AS0400X PA-3632 Colorado

Profile Details

NPI number 1740279884
LBN Legal business name Kidd, Justin L
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 20th, 2005
Last updated Feb 16th, 2024 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1740279884 NPPES
Colorado MEDICAID 38527057

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