Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Ethan Shane Kidd

Individual provider Peer Specialist · NPI 1972357739

Ethan Shane Kidd is a Peer Specialist in Tulsa, Oklahoma. Registered with an NPI since 2024.

In the registry since
2024

Practice location Address checks out

6128 E 38th St
Tulsa, OK 74135-5832
Phone: (918) 779-7144
Fax: (918) 663-0203
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Peer Specialist (primary) Taxonomy 175T00000X

Record details

NPI number1972357739
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedApril 16, 2024
Last updated in NPPESApril 16, 2024
Certification dateApril 16, 2024
Mailing address6128 E 38th St, Tulsa, OK 74135-5832

Other providers in Tulsa