JESSICA KING TIDWELL (NPI# 1629454160) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629454160 |
| Entity Type | Individual |
| Full Name | JESSICA KING TIDWELL |
| Credential | AGACNP-BC |
| Practice Address |
703 S Fleishel Ave Ste 5000 Tyler TX 75701-2015 |
| Mailing Address |
1501 Kings Highway Attn: Leisa Oglesby (med Sch Rm 1-201) Shreveport LA 71103-4228 |
| Practice Telephone | 9036062830 |
| Mailing Telephone | 3186754881 |
| Mailing Fax Number | 3186755069 |
| Enumeration Date | 2015-08-06 |
| Last Update Date | 2018-10-22 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LA2100X |
Nurse Practitioner Specialization: Acute Care |
AP130723 | TX | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363LA2100X |
Nurse Practitioner Specialization: Acute Care |
AP08445 | LA | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | 352279902 | 05 | |
| TX | RAIL ROAD MEDICARE | P01784015 | 01 |
| TX | TRICARE | 752616977180 | 01 |
| TX | TRICARE | 75-2616977-123 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376009431 | Jessica Leeann Tidwell | Behavior Technician | 4910 E Ashlan Ave Ste 118, Fresno, CA 93726-3021 | 2019-02-13 |
| 1649655531 | Jessica Tidwell | Nurse Practitioner | 209 S Royal Oaks Blvd, #222, Franklin, TN 37064-1310 | 2015-07-21 |
| 1023399946 | Jessica Tidwell | Social Worker | 13101 Allen Rd, Southgate, MI 48195-2216 | 2011-09-06 |
| Street Address |
703 S FLEISHEL AVE STE 5000 |
| City | TYLER |
| State | TX |
| Zip Code | 75701-2015 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467444141 | Thomas R Scholler | Physician Assistant | 703 S Fleishel Ave, Tyler, TX 75701-2015 | 2005-08-18 |
| 1922641299 | Marcus Evans | Nurse Practitioner | 703 S Fleishel Ave, Tyler, TX 75701-2015 | 2019-10-19 |
| 1144771288 | Toby C Silvertooth | Nurse Practitioner | 703 S Fleishel Ave, Ste. 4000, Tyler, TX 75701-2015 | 2016-10-24 |
| 1649721366 | Max T Tijerino | Physician Assistant | 703 S Fleishel Ave, Ste 5000, Tyler, TX 75701-2015 | 2016-10-18 |
| 1356892277 | Christus Trinity Clinic - Cardiology | Clinic/Center | 703 S Fleishel Ave, Suite 4000, Tyler, TX 75701-2015 | 2016-10-14 |
| 1891245734 | Rene Richter | General Acute Care Hospital | 703 S Fleishel Ave, Suite 5000, Tyler, TX 75701-2015 | 2016-10-04 |
| 1578915633 | Brandi L Holcomb | Nurse Practitioner | 703 S Fleishel Ave, Ste 5000, Tyler, TX 75701-2015 | 2016-07-12 |
| 1093030934 | Ramon Kumar | Internal Medicine | 703 S Fleishel Ave, Ste 4000, Tyler, TX 75701-2015 | 2010-04-04 |
| 1639344310 | Sheldon Ygnacio Freeberg | Internal Medicine | 703 S Fleishel Ave, Suite 4000, Tyler, TX 75701-2015 | 2008-04-24 |
| 1811048697 | Marina Yurievna Flaskas | Internal Medicine | 703 S Fleishel Ave, Ste 4000, Tyler, TX 75701-2015 | 2007-01-16 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962057059 | Gonzalo Fernandez | Physical Therapy Assistant | 753 S Beckham Ave, Tyler, TX 75701 | 2019-08-06 |
| 1215422654 | Adrianna Bussell | Nurse Practitioner | 1000 South Beckham, Tyler, TX 75701 | 2018-06-28 |
| 1285128017 | Idowu Akintokunbo Akinyele | Dentist | Aspen Dental, 4164 S Broadway Ave, Tyler, TX 75701 | 2018-06-15 |
| 1992208912 | Heather Renee Vancleave | Occupational Therapy Assistant | 1228 Louann Lane, Tyler, TX 75701 | 2018-03-15 |
| 1497260533 | Smile Workshop Mckinney, Pllc | Dentist | 301 N. Custer Rd, Mckinney, TX 75701 | 2017-12-12 |
| 1396266441 | Eye Surgery Center of East Texas, Pllc | Clinic/Center | 2448 E 5th St, Tyler, TX 75701 | 2017-06-29 |
| 1962936369 | Collins Complete Family Care | Nurse Practitioner | 1910 E Se Loop 323 # 176, Tyler, TX 75701 | 2017-04-12 |
| 1386187052 | Fellowship Health Team LLC | Home Health | 1124 S Fleishel Ave, Tyler, TX 75701 | 2016-11-29 |
| 1205382454 | Brenton Robinson | Nurse Practitioner | 1100 East Lake St, 160, Tyler, TX 75701 | 2016-08-28 |
| 1851846208 | Care First Pharmacy, LLC | Pharmacy | 1910 Roseland Blvd A, Tyler, TX 75701 | 2016-08-15 |
| Find all providers in zip 75701 | ||||
| Taxonomy Code | 363LA2100X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Acute Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568071116 | Carie Elise Bodnar | Nurse Practitioner | 910 E Houston St Ste 500, Tyler, TX 75702-8365 | 2020-07-29 |
| 1821461070 | Matthew Applegate | Nurse Practitioner | 700 Olympic Plaza Cir Ste 407, Tyler, TX 75701-1952 | 2015-11-10 |
| 1053401588 | Rebecca A Turner | Nurse Practitioner | 1133 Medical Drive, Tyler, TX 75701 | 2006-10-13 |
| 1225049083 | Alice Meredithe Nix | Nurse Practitioner | 1530 Ssw Loop 323, Suite 123, Tyler, TX 75701-2562 | 2006-08-10 |
| 1174130462 | Jessica Lemoine Phillips | Nurse Practitioner | 800 E Dawson St, Tyler, TX 75701-2036 | 2020-09-30 |
| 1366051526 | Bessie Burchfield | Nurse Practitioner | 800 E Dawson St, Tyler, TX 75701-2036 | 2020-07-23 |
| 1033739388 | Eric Bradley Vogt | Nurse Practitioner | 800 E Dawson St, Tyler, TX 75701-2036 | 2020-04-16 |
| 1922641299 | Marcus Evans | Nurse Practitioner | 703 S Fleishel Ave, Tyler, TX 75701-2015 | 2019-10-19 |
| 1578105771 | Haley Renee Dias | Nurse Practitioner | 4111 University Blvd, Tyler, TX 75701-6623 | 2019-10-09 |
| 1346718939 | Amber Dionne Wood | Nurse Practitioner | 619 S Fleishel Ave Ste 100, Tyler, TX 75701-2004 | 2018-11-13 |
| Find all providers in TYLER | ||||
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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.