MR. DONALD GREGORY TISDALE JR. (NPI# 1174006522) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174006522 |
| Entity Type | Individual |
| Full Name | MR. DONALD GREGORY TISDALE JR. |
| Other Name | GREG TISDFALE |
| Credential | NP |
| Practice Address |
1227 N State St Ste 101 Jackson MS 39202-2002 |
| Mailing Address |
450 Towne Center Blvd Ridgeland MS 39157-4804 |
| Practice Telephone | 6013552485 |
| Mailing Telephone | 6018981053 |
| Enumeration Date | 2018-09-12 |
| Last Update Date | 2019-08-09 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
902899 | MS | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
1227 N STATE ST STE 101 |
| City | JACKSON |
| State | MS |
| Zip Code | 39202-2002 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639119589 | Justin T Baker | Internal Medicine | 1227 N State St Ste 101, Jackson, MS 39202-2002 | 2006-06-08 |
| 1043841265 | Rachael Greer | Nurse Practitioner | 1227 N State St Ste 101, Jackson, MS 39202-2002 | 2020-01-27 |
| 1053812545 | Brandon Benson | Pharmacist | 1227 N State St Ste 101, Jackson, MS 39202-2002 | 2018-02-21 |
| 1780192690 | Jackson Oncology Associates | Pharmacy | 1227 N State St Ste 101, Jackson, MS 39202-2002 | 2018-01-12 |
| 1306043278 | Elizabeth Herrington | Internal Medicine | 1227 N State St Ste 101, Jackson, MS 39202-2002 | 2007-07-02 |
| 1518178524 | Natale Tate Sheehan | Internal Medicine | 1227 N State St Ste 101, Jackson, MS 39202-2002 | 2007-05-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982234183 | Eva Mackenzie Carmody | Physician Assistant | 1190 N State St Suite 502, Jackson, MS 39202 | 2020-01-16 |
| 1750868691 | Katherine Walters | Nurse Practitioner | 501 Marshall St., Suite 400, Jackson, MS 39202 | 2018-07-24 |
| 1932638749 | Tylan Lee | Social Worker | 860 East River Place Suite 100, Jackson, MS 39202 | 2017-06-06 |
| 1417314725 | Euna Jyles | Counselor | 860 E River Pl, Jackson, MS 39202 | 2016-01-19 |
| 1255712048 | Edward Jonathan Breight | Specialist/Technologist | 1325 East Fortication Street, Jackson, MS 39202 | 2015-06-17 |
| 1881037703 | Kara Spinks Logan | Surgery | 1190 N State St Ste 502, Jackson, MS 39202 | 2013-04-10 |
| 1477876530 | Mick Inc. | Technician | 334 Josanna Street, Suite #209, Jackson, MS 39202 | 2010-03-03 |
| 1073724910 | Paul Frederic Dare | Anesthesiology | 1151 North State St., Suite 311, Jackson Anesthesia Associates, Jackson, MS 39202 | 2007-05-24 |
| 1225247703 | Lynn Kincannon Holland | Counselor | 911 Manship Street, Unit A, Jackson, MS 39202 | 2007-05-22 |
| 1457568149 | Incare Inc | Pulmonary Function Technologist | 1151 North State St, Suite 406, Jackson, MS 39202 | 2007-05-16 |
| Find all providers in zip 39202 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073113627 | Jessicah Blasdel | Nurse Practitioner | 113 W Michigan Ave, Jackson, MI 49201-1340 | 2020-10-31 |
| 1801406335 | Jade Russell | Nurse Practitioner | 2205 W Morrell St, Jackson, MI 49203-1357 | 2020-08-10 |
| 1992315212 | Patrecia Campbell | Nurse Practitioner | 2570 Bailey Ave Ste 7, Jackson, MS 39213-6905 | 2020-08-01 |
| 1669008926 | Kristine Edwards | Nurse Practitioner | 723 Woodlawn Ave, Jackson, MI 49203-2921 | 2020-03-19 |
| 1295366391 | Christy White | Nurse Practitioner | 363 Old Pinson Rd, Jackson, TN 38301-9576 | 2020-01-28 |
| 1972141620 | Primary Care - Bemis, LLC | Nurse Practitioner | 1385 S Highland Ave Ste B4, Jackson, TN 38301-7547 | 2019-12-12 |
| 1174164263 | Tami Anne Miller | Nurse Practitioner | 124 N Bast St, Jackson, MO 63755-1704 | 2019-10-01 |
| 1265080584 | Cameron Nicole Howard | Nurse Practitioner | 1860 Chadwick Dr Ste 256, Jackson, MS 39204-3486 | 2019-08-29 |
| 1831750843 | Rhiannon Michelle Andresen | Nurse Practitioner | 1022 Greystone Sq, Jackson, TN 38305-3580 | 2019-06-21 |
| 1902376361 | Jenay B Krumm | Nurse Practitioner | 1201 E Michigan Ave Ste 200, Jackson, MI 49201-1855 | 2018-11-28 |
| Find all providers in JACKSON | ||||
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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.