person
Ricky L Kidman, PA-C
Medical Physician Assistant in Aynor, South Carolina
NPI 1962466532

Ricky L Kidman is a Medical Physician Assistant based in Conway, SC and is specialized in Medical. Ricky L Kidman practices in Aynor, SC and has the professional credentials of PA-C. The NPI Number for Ricky L Kidman is 1962466532 and holds a License No. 1094 (South Carolina).

The current practice location address for Ricky L Kidman is 51 11Th Avenue, Aynor, SC and can be reached out via phone at 843-358-3700 and via fax at 843-358-3707. You can also correspond with Ricky L Kidman through the mailing address at 300 SINGLETON RIDGE RD, CONWAY, SC - 29526-9142 (mailing address contact number: 843-234-6946).

Location: 51 11Th Avenue, Aynor, SC, 29526-9142
person
Provider Profile Details
NPI Number
1962466532
Provider Name
Ricky L Kidman
Credential
PA-C
Provider Entity Type
Individual
Gender
Male
Address
51 11Th Avenue, Aynor, SC, 29526-9142
Phone Number
843-358-3700
Fax Number
843-358-3707
Provider Enumeration Date
04/12/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
1140PA 05 SC
institution
Provider Business Practice Location Address Details
Address
51 11Th Avenue
City
State
Zip
29511-3249
Phone Number
843-358-3700
Fax Number
843-358-3707
person
Provider Business Mailing Address Details
Address
51 11Th Avenue
City
State
Zip
29511-3249
Phone Number
843-358-3700
Fax Number
843-358-3707
person
Provider's Taxonomy Details 1
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Physician Assistant
Speciality
Medical
Taxonomy
License No.
1094 (South Carolina)
Definition
Definition to come...
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