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General NPI Number Information
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NPI Number | 1023380474
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Entity Type | Organization
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Legal Business Name | FAMILY PRACTICE CLINIC, PC
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Dates
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Enumeration Date | 02/01/2012
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Last Update Date | 11/20/2025
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Provider Practice Location Address
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Address Line | 1445 PARR AVE
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City | DYERSBURG
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State | TN
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Zip | 38024-3153
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Country | US
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Telephone | 731-286-6156
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Fax | 731-286-6797
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Provider Business Mailing Address
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Address Line | 1445 PARR AVE
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City | DYERSBURG
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State | TN
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Zip | 38024-3153
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Country | US
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Telephone | 731-286-6156
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Fax | 731-286-6797
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | MS. SHARI P TIDWELL
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Credential | APRN, FNP-C
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Telephone | 731-286-6156
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 6331
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License Number State | TN
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