| Doctor Name: | MONA KIDWELL |
| NPI Number: | 1043571243 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | N.P. |
| License Number: | 508280 |
| Business Practice Address: | 2785 Gulf Fwy S Suite 115 League City, TX - 775734979 |
| Business Phone Number: | 8328161370 |
| Business Fax Number: | |
| Mailing Address: | 2785 Gulf Fwy S, Suite 115 LEAGUE CITY |
| State: | TX |
| Postal Code: | 775734979 |
| Phone Number: | 8328161370 |
| Fax Number: | |
| NPI Enumeration Date: | 06/04/2012 |
| NPI Last Update Date: | 06/07/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2200X |
| License Number: | 508280 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Adult Health |
| Taxonomy Definition: | |