Provider Demographics
NPI:1992677165
Name:KIDD, DENISE (LPN)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:KIDD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4038 MONTVALE RD
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37803-3205
Mailing Address - Country:US
Mailing Address - Phone:865-363-0629
Mailing Address - Fax:
Practice Address - Street 1:4038 MONTVALE RD
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37803-3205
Practice Address - Country:US
Practice Address - Phone:865-363-0629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-18
Last Update Date:2025-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN85475164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse