LAURA R KIDD (NPI# 1396842480) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1396842480 |
| Entity Type | Individual |
| Full Name | LAURA R KIDD |
| Other Name | LAURA R WILLENBORG |
| Credential | P.A. |
| Practice Address |
305 W Jackson St Ste 200 Carbondale IL 62901-1474 |
| Practice Telephone | (618) 536-6621 |
| Practice Fax Number | 6184531102 |
| Mailing Telephone | 6185366621 |
| Mailing Fax Number | 6184531102 |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2018-10-09 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 085.002750 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | PHYSICIAN ASSISTANT LICENSE | 085-002750 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720515083 | Laura Christine Kidd | Urology | 3401 N Broad St, Philadelphia, PA 19140-5103 | 2017-05-17 |
| 1023481579 | Laura Marie Kidd | Counselor | 1206 N Main St, North Canton, OH 44720-1926 | 2015-11-05 |
| 1174885669 | Laura Robinson Kidd | Pathology | 503 Mcmillan Rd, West Monroe, LA 71291 | 2012-06-12 |
| 1144537408 | Laura Kidd | Counselor | 3445 S Main St, Coventry Township, OH 44319 | 2010-09-08 |
| 1306003751 | Laura Kidd | Counselor | 124 S 24th St, Ste 230, Omaha, NE 68102-1226 | 2008-05-21 |
| Street Address |
305 W JACKSON ST STE 200 |
| City | CARBONDALE |
| State | IL |
| Zip Code | 62901-1474 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073599767 | Erhime T Badejo | Registered Nurse | 305 W Jackson St Ste 200, Carbondale Family Medicine, Carbondale, IL 62901-1474 | 2005-12-15 |
| 1972165918 | Andrew Jeffry Vanscoyk | Family Medicine | 305 W Jackson St Ste 200, Carbondale, IL 62901-1474 | 2019-06-30 |
| 1720649858 | David Heath Trahan | Family Medicine | 305 W Jackson St Ste 200, Carbondale, IL 62901-1474 | 2019-06-28 |
| 1407416308 | Nicole Poythress Waters | Family Medicine | 305 W Jackson St Ste 200, Carbondale, IL 62901-1474 | 2019-06-13 |
| 1548827124 | Max Crouse | Family Medicine | 305 W Jackson St Ste 200, Carbondale, IL 62901-1474 | 2019-05-20 |
| 1336605237 | Macy L Henson | Physician Assistant | 305 W Jackson St Ste 200, Carbondale, IL 62901-1474 | 2019-02-15 |
| 1821583964 | Dois Charles Ogan | Family Medicine | 305 W Jackson St Ste 200, Carbondale, IL 62901-1474 | 2018-06-29 |
| 1396239455 | Nicole Gyasi | Family Medicine | 305 W Jackson St Ste 200, Carbondale, IL 62901-1474 | 2018-06-21 |
| 1578057873 | Sohaib Sajjad | Family Medicine | 305 W Jackson St Ste 200, Carbondale, IL 62901-1474 | 2018-06-20 |
| 1285128504 | Charelle Octavia Smith | Family Medicine | 305 W Jackson St Ste 200, Carbondale, IL 62901-1474 | 2018-06-20 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558961268 | Gerad Aaron Harsy | Pharmacist | Walmart Pharmcy, 1450 East Main St, Carbondale, IL 62901 | 2020-10-30 |
| 1437708674 | Board of Trustees of Southern Illinois University | Clinic/Center | 300 W Oak Street, Carbondale, IL 62901 | 2019-09-10 |
| 1306317383 | Rachael O Johnson | Nurse Practitioner | 404 S. Lewis Ln, Carbondale, IL 62901 | 2018-12-17 |
| 1740795194 | Megan Marie Zimmerman | Nurse Practitioner | 1100 W Diann Ln., Carbondale, IL 62901 | 2017-12-07 |
| 1295244242 | Amy Elizabeth Prudencio | Social Worker | 1301 E. Walnut Street, Carbondale, IL 62901 | 2017-09-21 |
| 1740708171 | Theresa Aleise Goodin | Speech-Language Pathologist | 1301 East Walnut Street, Carbondale, IL 62901 | 2017-09-06 |
| 1144762527 | Kathleen Chwalisz Rigney | Psychologist | 306 West Mill Street, Neurorestorative, Carbondale, IL 62901 | 2016-11-16 |
| 1285185173 | Shawnee Health Service and Development Corp | Social Worker | 404 S. Lewis Lane, Carbondale, IL 62901 | 2016-10-17 |
| 1437605094 | Arielle Greer | Nurse's Aide | 510 E. Russell St., A, Carbondale, IL 62901 | 2016-09-01 |
| 1518413863 | Complete Family Eyecare of Carbondale, PC | Optometrist | 1241 East Walnut Street, Carbondale, IL 62901 | 2016-08-28 |
| Find all providers in zip 62901 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821618471 | Derrik Abell | Physician Assistant | 11648 Rolling Meadows Ln, Carbondale, IL 62901-0750 | 2020-04-23 |
| 1598277907 | Mallory Lindberg | Physician Assistant | 207 W Jackson St Ste 201, Carbondale, IL 62901-1408 | 2017-10-26 |
| 1790009488 | Northeast Physician Housecalls, Inc. | Physician Assistant | 52 Dundaff St, Carbondale, PA 18407-1879 | 2010-03-24 |
| 1164618633 | Rachel Marie Sargent | Physician Assistant | 600 N. Giant City Rd, Carbondale, IL 62902-6413 | 2007-09-19 |
| 1851502421 | Kelly K Hand | Physician Assistant | 665 E Lake Rd, Carbondale, IL 62901-5347 | 2007-05-25 |
| 1073729877 | Kathleen Ann Dodd | Physician Assistant | 374 East Grand, Carbondale, IL 62901-6740 | 2007-05-16 |
| 1376680462 | Gabriel A Martin | Physician Assistant | 103 S Washington St, Suite 202, Carbondale, IL 62901-3030 | 2007-01-30 |
| 1649385873 | Mary L Brandenburg | Physician Assistant | 1301 E Walnut St, Carbondale, IL 62901-5004 | 2006-08-20 |
| 1841237120 | Patricia A Boudet | Physician Assistant | 404 S Lewis Ln, Carbondale, IL 62901-3547 | 2006-06-02 |
| 1871542811 | Michael Anthony Bryant | Physician Assistant | 305 W Jackson St Ste 103, Carbondale, IL 62901-1474 | 2006-05-08 |
| Find all providers in CARBONDALE | ||||
| City | CARBONDALE |
| Zip Code | 62901 |
Please comment or provide details below to improve the information on LAURA R KIDD.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.