Provider Demographics
NPI:1093581068
Name:KIDKA, HELEN TEAHTON
Entity type:Individual
Prefix:MRS
First Name:HELEN
Middle Name:TEAHTON
Last Name:KIDKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:539 BALD EAGLE DR
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95688-1021
Mailing Address - Country:US
Mailing Address - Phone:707-400-8873
Mailing Address - Fax:
Practice Address - Street 1:650 HOWE AVE STE 600
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-4797
Practice Address - Country:US
Practice Address - Phone:916-953-7571
Practice Address - Fax:916-771-8515
Is Sole Proprietor?:No
Enumeration Date:2023-11-30
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAF10230736363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily