Keith L Kidd, FNP-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

13254 Issued in TN

Practice address

9026 Hiwassee St NE
Charleston, TN 37310-5305

Phone

(423) 665-3666

Fax

(423) 584-6747

NPI assigned

Mar 17, 2008

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 3

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in TN

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

Nurse Practitioner

Education

Other, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Preferred Family Medical Care LLCGroup PAC ID 6800013608, 3 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Amedisys Home Health Chattanooga Home health agency, Chattanooga, TN, CCN 447156

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kkidd@pfmcl-tn.direct.office.nextgen.com
• FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.140.71045
• FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/
• Direct secure messaging: keith.kidd.1@9245.direct.athenahealth.com

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.

• Preferred Family Medical Care LLC

  • Primary Care Clinic/Center
  • Charleston, TN
  • NPI 1699188029
  Medicare reassignment Care Compare group NPD Authorized official
• Medisleep LLC

  • Sleep Disorder Diagnostic Clinic/Center
  • Chattanooga, TN
  • NPI 1730410440
  NPD (past)
• Premier Surgical Associates, PLLC

  • Prosthetic/Orthotic Supplier
  • Knoxville, TN
  • NPI 1285806919
  NPD (past)
• Sibaji Shome MD PLLC

  • Pulmonary Disease Physician
  • Chattanooga, TN
  • NPI 1962722496
  NPD (past)

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

• Comprehensive Home Healthcare Services LLC

  dba Amedisys Home Health

  • Home Health Agency
  • Chattanooga, TN
  • NPI 1326096009
  Care Compare affiliation

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

{
    "created_epoch": "1205712000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635465600000",
    "number": "1811168941",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 15",
            "city": "CHARLESTON",
            "state": "TN",
            "postal_code": "373100015",
            "telephone_number": "423-665-3666",
            "fax_number": "423-584-6747"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9026 HIWASSEE ST NE",
            "city": "CHARLESTON",
            "state": "TN",
            "postal_code": "373105305",
            "telephone_number": "423-665-3666",
            "fax_number": "423-584-6747"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9026 Hiwassee St NE",
            "address_purpose": "LOCATION",
            "city": "Charleston",
            "state": "TN",
            "postal_code": "373105305",
            "country_code": "US",
            "telephone_number": "423-665-3666",
            "fax_number": "423-584-6747",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIDD",
        "first_name": "KEITH",
        "middle_name": "L",
        "name_prefix": "Mr.",
        "credential": "FNP-BC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-03-17",
        "last_updated": "2021-10-29",
        "certification_date": "2021-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "13254",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q007277",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIGROUP",
            "identifier": "02684136",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "3476201",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "keith.kidd.1@9245.direct.athenahealth.com",
            "affiliation": "N",
            "endpointDescription": "keith.kidd.1@9245.direct.athenahealth.com",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "9026 Hiwassee St NE",
            "city": "Charleston",
            "state": "TN",
            "country_code": "US",
            "postal_code": "373105305",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Athens Physicians Practice LLC (Starr Convenient Care - Charleston)
• Eugene Baker, DPH
• Katelyn Cantrell
• James Clifton Griffin, RPH
• Kavin J Johnson, MD
• Deloyn L McDonough, PA-C
• Danny Ray Nelson, NP-C
• Thomas Odom
• Preferred Family Medical Care LLC
• Preferred Family Pharmacy LLC

• Family Nurse Practitioner in Charleston, TN
• Providers in Charleston, TN by specialty
• Family Nurse Practitioner in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2021; 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.