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NPI Code Detail

MEDICARE: KATIE ELIZABETH TIDWELL FNP

MEDICARE: KATIE ELIZABETH TIDWELL FNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse PractitionerF12230861TN

General Provider Information

NPI Number : 1235908351
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATIE ELIZABETH TIDWELL FNP
Provider Business Mailing Address
First Line : 765 WOODLAND TRACE LN
Second Line :
City : CORDOVA
State : TN
Zip : 38018-6609
Country : US
Telephone Number : 888-551-2538
Fax Number :
Provider Business Practice Location Address
First Line : 765 WOODLAND TRACE LN
Second Line :
City : CORDOVA
State : TN
Zip : 38018-6609
Country : US
Telephone Number : 888-551-2538
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/29/2023
Last Update Date : 12/16/2025

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