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General NPI Number Information
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NPI Number | 1396418679
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Entity Type | Individual
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Provider Name | KRISTIN TIDWELL APRN, FNP-C
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Gender | Female
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Dates
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Enumeration Date | 07/31/2021
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Last Update Date | 07/31/2021
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Provider Practice Location Address
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Address Line | 1008 W TAFT AVE
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City | SAPULPA
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State | OK
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Zip | 74066-8720
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Country | US
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Telephone | 918-347-8090
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Fax |
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Provider Business Mailing Address
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Address Line | 10488 S 86TH EAST AVE
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City | TULSA
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State | OK
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Zip | 74133-7084
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | R0111034
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License Number State | OK
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