Angelia Grace Kidwell, PTA

Key facts

NPI

1265947154

Entity type

Individual (NPI type 1)

Primary specialty

Physical Therapy Assistant 225200000X

License

PTA980 (AR)

Practice address

168 W College Ave
Monticello, AR 71655-4820

Phone

(870) 367-4333

NPI assigned

Dec 13, 2017

Sex

Female

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Dec 13, 2017.

{
    "created_epoch": "1513123200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1513123200000",
    "number": "1265947154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "207 N FARMVILLE RD",
            "city": "HERMITAGE",
            "state": "AR",
            "postal_code": "716479390",
            "telephone_number": "870-463-8846"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "168 W COLLEGE AVE",
            "city": "MONTICELLO",
            "state": "AR",
            "postal_code": "716554820",
            "telephone_number": "870-367-4333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIDWELL",
        "first_name": "ANGELIA",
        "middle_name": "GRACE",
        "name_prefix": "Mrs.",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-12-13",
        "last_updated": "2017-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "AR",
            "license": "PTA980",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Monticello, AR

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• Helen Regina Junior
• Stacy Elizabeth Justice, PT
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• Ashley Deshea Kelnhofer, MS, CCC-SLP
• Lisa Kilcrease, LCSW
• Lesa Kilpatrick, LCSW
• Floice Knapp
• Donald Franklin Koen, PD
• Kaitlyn Lacaze

All providers in Monticello, AR · Physical Therapy Assistant in Arkansas