Provider Demographics
NPI:1861809998
Name:LIDZ, KATHERINE KELLY (ARNP)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:KELLY
Last Name:LIDZ
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1983 NEWBERRY LN
Mailing Address - Street 2:
Mailing Address - City:TEGA CAY
Mailing Address - State:SC
Mailing Address - Zip Code:29708-8438
Mailing Address - Country:US
Mailing Address - Phone:803-619-9846
Mailing Address - Fax:803-913-5275
Practice Address - Street 1:6520 SW THISTLE TER
Practice Address - Street 2:
Practice Address - City:PALM CITY
Practice Address - State:FL
Practice Address - Zip Code:34990-3857
Practice Address - Country:US
Practice Address - Phone:803-619-9846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-21
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9424269363LP0808X
FLRN9424269163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health