Stephanie Kidwell

Primary specialty

Peer SpecialistTaxonomy code 175T00000X

License

MPSS-VK5FJX Issued in CA

Practice address

258 N Thompson St
Hemet, CA 92543-4311

Phone

(951) 534-9003

NPI assigned

Mar 29, 2022

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1648512000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732060800000",
    "number": "1124768155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "258 N THOMPSON ST",
            "city": "HEMET",
            "state": "CA",
            "postal_code": "925434311",
            "telephone_number": "951-534-9003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "258 N THOMPSON ST",
            "city": "HEMET",
            "state": "CA",
            "postal_code": "925434311",
            "telephone_number": "951-534-9003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIDWELL",
        "first_name": "STEPHANIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-03-29",
        "last_updated": "2024-11-20",
        "certification_date": "2024-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "CA",
            "license": "MPSS-VK5FJX",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Balraj Singh Khehra, P.T.
• Brian Zachary Khin, DO
• Vikrant Singh Khosa, DO
• Ardeshir Khosraviani, M.D.
• Kidney Train LLC.
• Kevin Jacob Kilmurray
• Hyun Kyung Kim, PHARM. D.
• Joshua Ho Young Kim, MD
• Katrina Hyunsook Kim, PT, DPT
• Ryan Wonjun Kim

• Peer Specialist in Hemet, CA
• Providers in Hemet, CA by specialty
• Peer Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.