Provider Demographics
NPI:1881173490
Name:KIDD, ALICIA BETH (APRN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:BETH
Last Name:KIDD
Suffix:
Gender:F
Credentials:APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6780 HORIZON RD STE 102
Mailing Address - Street 2:
Mailing Address - City:HEATH
Mailing Address - State:TX
Mailing Address - Zip Code:75032-2104
Mailing Address - Country:US
Mailing Address - Phone:888-877-6395
Mailing Address - Fax:
Practice Address - Street 1:203 W PATISON ST STE B
Practice Address - Street 2:
Practice Address - City:PORT HADLOCK
Practice Address - State:WA
Practice Address - Zip Code:98339-8701
Practice Address - Country:US
Practice Address - Phone:360-251-0898
Practice Address - Fax:360-251-0863
Is Sole Proprietor?:No
Enumeration Date:2018-08-14
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61190565363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1790731081Medicaid