Individual provider Active NPI

Amparo Emilia Kidd, ANP

  • Adult Health Nurse Practitioner
  • Chantilly, VA
National Provider Identifier
1326419078
Registry record updated Aug 24, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
COA.18174-NP Issued in OH
Practice address
14121 Parke Long Court
Suite 201
Chantilly, VA 20151
Phone
(571) 364-7110
NPI assigned
Oct 7, 2015
Last updated
Aug 24, 2021By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 24, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X COA.18174-NP OH Primary

Addresses

Primary practice location

14121 Parke Long Court
Suite 201
Chantilly, VA 20151

Mailing address

500 Kirts Blvd Ste 100
Troy, MI 48084-4135
Phone (248) 434-6169

Other practice location 1

4435 Aicholtz Rd Ste 200
Cincinnati, OH 45245-1692
Phone (513) 947-0400

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180119002032 OH Practitioner - Nurse Practitioner 9133488117 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
COA.18174-NPOHMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Vpa PC Current Accepting new patients
Vpa PC CurrentSince Oct 13, 2021 Accepting new patients
Vpa PC Current Accepting new patients
Vpa PC CurrentSince Oct 13, 2021 Accepting new patients

Locations

500 Kirts Blvd
Ste 100
Troy, MI 48084
Phone (214) 824-6000

4435 Aicholtz Rd
Ste 200
Cincinnati, OH 45245
Phone (513) 947-0400

4435 Aicholtz Rd
Ste 400
Cincinnati, OH 45245
Phone (513) 326-3007

3033 Kettering Blvd
Ste 100
Moraine, OH 45439
Phone (937) 293-2133

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1444176000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629763200000",
    "number": "1326419078",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 KIRTS BLVD STE 100",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480844135",
            "telephone_number": "248-434-6169",
            "fax_number": "855-618-6655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14121 PARKE LONG COURT",
            "address_2": "SUITE 201",
            "city": "CHANTILLY",
            "state": "VA",
            "postal_code": "20151",
            "telephone_number": "571-364-7110"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4435 Aicholtz Rd Ste 200",
            "address_purpose": "LOCATION",
            "city": "Cincinnati",
            "state": "OH",
            "postal_code": "452451692",
            "country_code": "US",
            "telephone_number": "513-947-0400",
            "fax_number": "513-947-0500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIDD",
        "first_name": "AMPARO",
        "middle_name": "EMILIA",
        "credential": "ANP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-10-07",
        "last_updated": "2021-08-24",
        "certification_date": "2021-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "OH",
            "license": "COA.18174-NP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chantilly, VA

Sources for this page

Verify at the official NPI Registry.