Provider Demographics
NPI:1215958848
Name:KIDWELL, FRANCIS E III (PA-C)
Entity type:Individual
Prefix:
First Name:FRANCIS
Middle Name:E
Last Name:KIDWELL
Suffix:III
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:KIP
Other - Middle Name:
Other - Last Name:KIDWELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 2699
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32513-2699
Mailing Address - Country:US
Mailing Address - Phone:850-863-3000
Mailing Address - Fax:850-862-1621
Practice Address - Street 1:2010 LEWIS TURNER BLVD
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-1352
Practice Address - Country:US
Practice Address - Phone:850-862-3000
Practice Address - Fax:850-862-1621
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9108502363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
S30473Medicare UPIN
WA8367898Medicaid
AB24882Medicare ID - Type UnspecifiedNORIDIAN