RICKY L KIDMAN (NPI# 1962466532) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1962466532 |
| Entity Type | Individual |
| Full Name | RICKY L KIDMAN |
| Credential | PA-C |
| Practice Address |
511 S Main St Mullins SC 29574-3509 |
| Practice Telephone | 8434648244 |
| Practice Fax Number | 8434646519 |
| Mailing Telephone | 8434648244 |
| Mailing Fax Number | 8434646519 |
| Enumeration Date | 2006-04-12 |
| Last Update Date | 2020-10-15 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207R00000X | Internal Medicine | 1094IM | SC | Allopathic & Osteopathic Physicians |
| Y | 363A00000X | Physician Assistant | 52-01094 | SC | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| SC | GP5462 | 05 |
| Street Address |
511 S MAIN ST |
| City | MULLINS |
| State | SC |
| Zip Code | 29574-3509 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043837669 | Medical University Hospital Authority | Internal Medicine | 511 S Main St, Mullins, SC 29574-3509 | 2020-06-30 |
| 1255896718 | Medical University Hospital Authority | Family Medicine | 511 S Main St, Mullins, SC 29574-3509 | 2019-02-08 |
| 1104147479 | Marion Physician Services LLC | Clinic/Center | 511 S Main St, Mullins, SC 29574-3509 | 2010-06-21 |
| 1972553691 | Marion Regional Healthcare System | Internal Medicine | 511 S Main St, Mullins, SC 29574-3509 | 2006-05-11 |
| 1982668745 | Gangatharan Mathisuthan | Internal Medicine | 511 S Main St, Mullins, SC 29574-3509 | 2006-04-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700412921 | Maria Roman | Physical Therapist | 2829 East, Us-76, Mullins, SC 29574 | 2020-03-19 |
| 1679959431 | Healthy Childsmiles, LLC | Clinic/Center | 4504 East Highway 76, Mullins, SC 29574 | 2015-08-04 |
| 1629327549 | Shirley Howell Rogers | Pharmacist | 4005 Cleve Mayers Ct, Mullins, SC 29574 | 2012-09-06 |
| 1588834147 | Monique Hemingway-bell | Speech-Language Pathologist | 2622 Troy Atkinson Road, Mullins, SC 29574 | 2008-03-10 |
| 1932226156 | Patient Response Organization Inc | Ambulance | 142 South Main St, Mullins, SC 29574 | 2007-03-23 |
| 1164573200 | Marion School District Seven | Local Education Agency (LEA) | 3559 South Highway 501, Mullins, SC 29574 | 2007-01-16 |
| 1932270279 | Franklin Gasque Mason | Dentist | 410 South Main St, Mullins, SC 29574 | 2006-11-10 |
| 1033138904 | Iris M Floyd-norris | Family Medicine | 2835 East Highway 76, Ste 7, Mullins, SC 29574 | 2006-07-19 |
| 1790721207 | Home Therapy Inc | Durable Medical Equipment & Medical Supplies | 3391 Hwy. 76 E., Mullins, SC 29574 | 2006-06-22 |
| 1205876273 | John C Bilder | Dentist | 410 South Main Street, Mullins, SC 29574 | 2006-06-07 |
| Find all providers in zip 29574 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376197384 | Dustin Eric Hayes | Physician Assistant | 2829 E Highway 76, Mullins, SC 29574-6035 | 2019-07-29 |
| 1164892063 | Chad Evan Watts | Physician Assistant | 2829 E Highway 76, Mullins, SC 29574-6035 | 2015-10-05 |
| 1003868761 | Harvey Willis Putnam Jr. | Physician Assistant | 2835 E Highway 76, Suite 3, Mullins, SC 29574-6038 | 2006-05-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639770712 | Hannah Jenkins | Physician Assistant | 780 Windrow Dr, Sumter, SC 29150-5318 | 2020-11-04 |
| 1255931283 | Sterling Simmons Capotosti | Physician Assistant | 1813 Joseph Cir, Florence, SC 29501-6339 | 2020-10-28 |
| 1538768098 | Hristos Stamatopoulos | Physician Assistant | 149 Independent Ln, Walterboro, SC 29488-6218 | 2020-10-25 |
| 1053910596 | Sarah Xiao Jing Jarema | Physician Assistant | 1211 Hadley Cir Unit 4301, Myrtle Beach, SC 29577-8219 | 2020-10-24 |
| 1063011062 | Sara Chmielewski | Physician Assistant | 283 Blvd De France, Parris Island, SC 29905 | 2020-10-21 |
| 1487252367 | Hannah Beddingfield | Physician Assistant | 200 Drury Ln, Mauldin, SC 29662-2228 | 2020-10-13 |
| 1275131054 | Ethan Brody Clontz | Physician Assistant | 1953 Pinehurst Ave, Charleston, SC 29414-6483 | 2020-10-13 |
| 1790383719 | Kaytlin Blake Hollingsworth | Physician Assistant | 2774 Shadow Ln, North Charleston, SC 29406-9065 | 2020-10-12 |
| 1487261509 | Reilly Kilpatrick | Physician Assistant | 1518 Blaze Ln, Charleston, SC 29412-8652 | 2020-09-24 |
| 1144836461 | Michael Joseph Haven | Physician Assistant | 221 Bayfront Dr Unit 224, Mount Pleasant, SC 29464-1825 | 2020-09-22 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.