Healthcare Provider Details

I. General information

NPI: 1093391724
Provider Name (Legal Business Name): MORGEN ASTON TIDWELL NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2021
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6150 US HIGHWAY 43
GUIN AL
35563-3529
US

IV. Provider business mailing address

6150 US HIGHWAY 43
GUIN AL
35563-3529
US

V. Phone/Fax

Practice location:
  • Phone: 205-468-2754
  • Fax: 205-468-3664
Mailing address:
  • Phone: 205-468-2754
  • Fax: 205-468-3664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-150866
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: