Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | 0101053595 | VA |
NPI | 1447232228 |
---|---|
Provider Name | Kristi G Kidd |
First Address | Lynchburg, VA 24502-4271 |
Second Address | Lynchburg, VA 24502-4271 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G72613 | (02) | VA |