Provider Demographics
NPI:1992314561
Name:KYDD, MEREDITH LEIGH (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:MEREDITH
Middle Name:LEIGH
Last Name:KYDD
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:MEREDITH
Other - Middle Name:LEIGH
Other - Last Name:RITZE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:31 VILLAGE SQ
Mailing Address - Street 2:
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824-2712
Mailing Address - Country:US
Mailing Address - Phone:978-322-6915
Mailing Address - Fax:
Practice Address - Street 1:31 VILLAGE SQ
Practice Address - Street 2:
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-2712
Practice Address - Country:US
Practice Address - Phone:978-322-6915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-29
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN282678363L00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner