Provider Demographics
NPI:1982438438
Name:SIDWELL, KELLY NICOLE
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:NICOLE
Last Name:SIDWELL
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 1:909 MAJORSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:WEST FINLEY
Mailing Address - State:PA
Mailing Address - Zip Code:15377-2112
Mailing Address - Country:US
Mailing Address - Phone:304-276-2472
Mailing Address - Fax:
Practice Address - Street 1:909 MAJORSVILLE RD
Practice Address - Street 2:
Practice Address - City:WEST FINLEY
Practice Address - State:PA
Practice Address - Zip Code:15377-2112
Practice Address - Country:US
Practice Address - Phone:304-276-2472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant