Most Relevant Information
Provider Data
| NPI Number: | 1003646266 |
| Provider Name: | AMY KIDWELL |
| Entity Type: | Individual |
| Taxonomy Code: | 3747P1801X |
| Specialty: | Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 08/02/2024 |
| Last Updated: | 08/02/2024 |
Provider Practice Location
3642 ED ARNOLD RD
AUGUSTA
WV
267048504
Practice Location Phone/Fax
| Phone: | 6812714363 |
| Fax: |
Provider Mailing Location
3642 ED ARNOLD RD
AUGUSTA
WV
267048504
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |