Ethan Shane Kidd
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 StTulsa, 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 number | 1972357739 |
|---|---|
| Entity type | Individual (Type 1) |
| Gender | Male |
| Sole proprietor | No |
| NPI enumerated | April 16, 2024 |
| Last updated in NPPES | April 16, 2024 |
| Certification date | April 16, 2024 |
| Mailing address | 6128 E 38th St, Tulsa, OK 74135-5832 |
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