Laura R Kidd, P.A.

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

085.002750 Issued in IL

Practice address

409 W Oak St
Carbondale, IL 62901-1414

Phone

(618) 529-4455

Fax

(618) 351-1287

NPI assigned

Sep 20, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Laura R Willenborg Former name

Electronic endpoints 6

Medicare fee-for-service enrollment

Enrolled in IL

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

Specialty

Physician Assistant

Education

Southern Illinois University School of Medicine, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Select Physical Therapy Holdings IncGroup PAC ID 9537076401, shared by 76 NPIs, 1,992 clinicians

Southern Illinois Hospital ServicesGroup PAC ID 2961310966, 12 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• LHC-Illinois Home Health Care Home health agency, Marion, IL, CCN 147716
• Herrin Hospital Hospital, Herrin, IL, CCN 140011
• Memorial Hospital of Carbondale Hospital, Carbondale, IL, CCN 140164
• Franklin Hospital Hospital, Benton, IL, CCN 141321
• Harrisburg Medical Center Hospital, Harrisburg, IL, CCN 140210
• Heartland Regional Medical Center Hospital, Marion, IL, CCN 140184

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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

• Southern Illinois Hospital Services

  dba Herrin Hospital

  • General Acute Care Hospital
  • Herrin, IL
  • NPI 1528158573
  Medicare reassignment Care Compare group NPD (past)
• Board of Trustees of Southern Illinois University

  dba Siu Center for Family Medicine

  • Primary Care Clinic/Center
  • Springfield, IL
  • NPI 1396097960
  Medicare reassignment NPD
• Board of Trustees of Southern Illinois University

  dba SIU Center for Family Medicine - Care-A-Van

  • Federally Qualified Health Center (FQHC)
  • Carbondale, IL
  • NPI 1568210425
  NPD
• Southern Illinois Hospital Services

  dba West Frankfort Family Medicine

  • Family Medicine Physician
  • West Frankfort, IL
  • NPI 1154408581
  NPD
• Prairie Cardiovascular Consultants LTD

  • Cardiovascular Disease Physician
  • Springfield, IL
  • NPI 1659539559
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Deaconess Regional Healthcare Services Illinois Inc

  dba Deaconess Illinois Medical Center

  • General Acute Care Hospital
  • Marion, IL
  • NPI 1750007266
  Care Compare affiliation
• Franklin Hospital District

  • Critical Access Hospital
  • Benton, IL
  • NPI 1699778951
  Care Compare affiliation
• Harrisburg Medical Center Inc

  • General Acute Care Hospital
  • Harrisburg, IL
  • NPI 1073580130
  Care Compare affiliation
• LHCG Xxxvii, LLC

  dba LHC-Illinois Home Health Care

  • Home Health Agency
  • Marion, IL
  • NPI 1740527407
  Care Compare affiliation
• Southern Illinois Hospital Services

  dba Memorial Hospital of Carbondale

  • General Acute Care Hospital
  • Carbondale, IL
  • NPI 1093801797
  Care Compare affiliation
• Southern Illinois Hospital Services

  dba Herrin Hospital

  • General Acute Care Hospital
  • Herrin, IL
  • NPI 1528158573
  Care Compare affiliation

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1785801600000",
    "number": "1396842480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3988",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629023988",
            "telephone_number": "618-457-5200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "409 W OAK ST",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629011414",
            "telephone_number": "618-529-4455",
            "fax_number": "618-351-1287"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "217 S Park Ave Ste 2",
            "address_purpose": "LOCATION",
            "city": "Herrin",
            "state": "IL",
            "postal_code": "629483611",
            "country_code": "US",
            "telephone_number": "618-529-4455",
            "fax_number": "618-351-1287",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3905 W Ernestine Dr",
            "address_purpose": "LOCATION",
            "city": "Marion",
            "state": "IL",
            "postal_code": "629595800",
            "country_code": "US",
            "telephone_number": "618-529-4455",
            "fax_number": "618-351-1287",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "100 Dr Warren Tuttle Dr",
            "address_purpose": "LOCATION",
            "city": "Harrisburg",
            "state": "IL",
            "postal_code": "629462718",
            "country_code": "US",
            "telephone_number": "618-529-4455",
            "fax_number": "618-351-1287",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIDD",
        "first_name": "LAURA",
        "middle_name": "R",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-20",
        "last_updated": "2026-08-04",
        "certification_date": "2026-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085.002750",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICIAN ASSISTANT LICENSE",
            "identifier": "085-002750",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lkidd16006@sih.direct-ci.com",
            "affiliation": "N",
            "address_1": "217 S Park Ave Ste 2",
            "city": "Herrin",
            "state": "IL",
            "country_code": "US",
            "postal_code": "629483611",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lkidd16006@sih.direct-ci.com",
            "affiliation": "N",
            "address_1": "100 Dr Warren Tuttle Dr",
            "city": "Harrisburg",
            "state": "IL",
            "country_code": "US",
            "postal_code": "629462718",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lkidd16006@sih.direct-ci.com",
            "affiliation": "N",
            "address_1": "409 W Oak St",
            "city": "Carbondale",
            "state": "IL",
            "country_code": "US",
            "postal_code": "629011414",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lkidd16006@sih.direct-ci.com",
            "affiliation": "N",
            "address_1": "3905 W Ernestine Dr",
            "city": "Marion",
            "state": "IL",
            "country_code": "US",
            "postal_code": "629595800",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lkidd16006@sih.direct-ci.com",
            "affiliation": "N",
            "address_1": "2553 Ken Gray Blvd",
            "city": "West Frankfort",
            "state": "IL",
            "country_code": "US",
            "postal_code": "628964174",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "laurakidd@siusm.allscriptsdirect.net",
            "affiliation": "N",
            "address_1": "305 W Jackson St Ste 200",
            "city": "Carbondale",
            "state": "IL",
            "country_code": "US",
            "postal_code": "629011474",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "LAURA",
            "last_name": "WILLENBORG",
            "middle_name": "R",
            "credential": "P.A.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Muhammad A Khan, MD
• Rizwan Ahmad Khan, M.D.
• Saqib Khan, MD
• Areen Khodabakhshian, MD
• Michelle Yvonne Kibby-Faglier
• Kidney Disease and Medicine Specialty Consultants LLC
• Kids' Cornerstone, LLC- a Counseling Center
• Jane Kidwell, LCPC
• Hochung Kim, FNP-BC, DNP
• Felicia Desha Kimbrough, FNP BC

• Physician Assistant in Carbondale, IL
• Providers in Carbondale, IL by specialty
• Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.