Blaine Michael Kidd

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

Practice address

900 N John R Wooden Dr
West Lafayette, IN 47907-2117

Phone

(800) 497-7678

NPI assigned

Sep 28, 2020

Sex

Male

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

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

{
    "created_epoch": "1601251200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1685059200000",
    "number": "1700493483",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3426 WAVERLY DR",
            "city": "LAFAYETTE",
            "state": "IN",
            "postal_code": "479097320",
            "telephone_number": "765-414-9245"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 N JOHN R WOODEN DR",
            "city": "WEST LAFAYETTE",
            "state": "IN",
            "postal_code": "479072117",
            "telephone_number": "800-497-7678"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIDD",
        "first_name": "BLAINE",
        "middle_name": "MICHAEL",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-09-28",
        "last_updated": "2023-05-26",
        "certification_date": "2023-05-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emily Marie Keleher, PHARMD, RPH
• Maureen Kelly, CPT, GFI, CPR/AED
• Kali Kennedy
• Kara Michelle Kessans, PT, DPT, ATC, CSCS
• Monica W Keyes, RN, NP, ANP-C
• Claire Malloy King, RDN, LD
• Maddison Kinnard
• Meghan Caitleen Kinney
• Kathryn Kintner
• Darie Kirschling

• Athletic Trainer in West Lafayette, IN
• Providers in West Lafayette, IN by specialty
• Athletic Trainer in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2023; 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.