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General NPI Number Information
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NPI Number | 1679962641
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Entity Type | Organization
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Legal Business Name | DR. KAREN A. TIDMORE
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Dates
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Enumeration Date | 01/14/2015
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Last Update Date | 01/14/2015
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Provider Practice Location Address
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Address Line | 1811 SHARP SPRINGS RD
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City | WINCHESTER
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State | TN
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Zip | 37398-4659
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Country | US
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Telephone | 931-967-7716
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Fax |
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Provider Business Mailing Address
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Address Line | 1811 SHARP SPRINGS RD
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City | WINCHESTER
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State | TN
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Zip | 37398-4659
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Country | US
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Telephone | 931-967-7716
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Fax |
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Authorized Official
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Title or Position | FAMILY PRACTICE
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Name | KAREN TIDMORE
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Credential |
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Telephone | 931-967-7716
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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 | APN0000015232
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | DO 0000000400
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License Number State | TN
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