Active NPI
Morgan Brianna Kidwell, PA
- Physician Assistant
- Lake Wales, FL
National Provider Identifier
1508529835
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA9115368
- Practice address
- 407 S 11TH St
Lake Wales, FL 33853-4243 - Phone
- (863) 419-8366
- NPI assigned
- Oct 13, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | FL | ||
| Physician Assistant | 363A00000X | PA9115368 | FL | Primary |
Addresses
Primary practice location
407 S 11TH St
Lake Wales, FL 33853-4243
Mailing address
407 S 11TH St
Lake Wales, FL 33853-4243
Phone (863) 419-8366
Other practice location 1
14320 Metropolis Ave Ste 1
Fort Myers, FL 33912-4539
Phone (239) 277-5770
Other practice location 2
12995 S Cleveland Ave Ste 184
Fort Myers, FL 33907-7703
Phone (239) 226-2727
Other practice location 3
2217 North Blvd W
Davenport, FL 33837-8990
Phone (863) 421-3456
Other names 1
- Morgan Brianna Andrews
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2021
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
2700 Healing Way
Wesley Chapel, FL 33543-5453
Hospital & facility affiliations
- Adventhealth Lake Wales
- Adventhealth Sebring
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Practice roles (1 of 3)
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Gulfstream Urology, PA | Current | Accepting new patients |
Locations
14320 Metropolis Ave
Ste 1
Fort Myers, FL 33912
Phone (239) 277-5770
Networks
- Optimum HealthCare HMO Network
- Freedom Health HMO Network
Interoperability endpoints
- mkidwell1678318@adventhealth.direct-ci.com
- https://api.platform.athenahealth.com/12899/brand/1/csg/1/fhir/r4
Organizations & group practices 2
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.
-
- Urology Physician
- Fort Myers, FL
- NPI 1255722203
Hospital & facility affiliations 2
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1634083200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1689292800000",
"number": "1508529835",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "407 S 11TH ST",
"city": "LAKE WALES",
"state": "FL",
"postal_code": "338534243",
"telephone_number": "863-419-8366"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "407 S 11TH ST",
"city": "LAKE WALES",
"state": "FL",
"postal_code": "338534243",
"telephone_number": "863-419-8366"
}
],
"practiceLocations": [
{
"address_1": "14320 Metropolis Ave Ste 1",
"address_purpose": "LOCATION",
"city": "Fort Myers",
"state": "FL",
"postal_code": "339124539",
"country_code": "US",
"telephone_number": "239-277-5770",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "12995 S Cleveland Ave Ste 184",
"address_purpose": "LOCATION",
"city": "Fort Myers",
"state": "FL",
"postal_code": "339077703",
"country_code": "US",
"telephone_number": "239-226-2727",
"fax_number": "239-939-9876",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "2217 North Blvd W",
"address_purpose": "LOCATION",
"city": "Davenport",
"state": "FL",
"postal_code": "338378990",
"country_code": "US",
"telephone_number": "863-421-3456",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "KIDWELL",
"first_name": "MORGAN",
"middle_name": "BRIANNA",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-10-13",
"last_updated": "2023-07-14",
"certification_date": "2023-07-14",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "FL",
"license": null,
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "FL",
"license": "PA9115368",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "MORGAN",
"last_name": "ANDREWS",
"middle_name": "BRIANNA",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Lake Wales, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2023; 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.