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Jessica King Tidwell, AGACNP-BC
Acute Care Nurse Practitioner in Tyler, Texas
NPI 1629454160

Jessica King Tidwell is an Acute Care Nurse Practitioner based in Shreveport, TX and is specialized in Acute Care. Jessica King Tidwell practices in Tyler, TX and has the professional credentials of AGACNP-BC. The NPI Number for Jessica King Tidwell is 1629454160 and holds a License No. AP08445 (Texas).

The current practice location address for Jessica King Tidwell is 703 S Fleishel Ave, Tyler, TX and can be reached out via phone at 903-606-2830.

Location: 703 S Fleishel Ave, Tyler, TX, 71103-4228
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Provider Profile Details
NPI Number
1629454160
Provider Name
Jessica King Tidwell
Credential
AGACNP-BC
Provider Entity Type
Individual
Gender
Female
Address
703 S Fleishel Ave, Tyler, TX, 71103-4228
Phone Number
903-606-2830
Fax Number
Provider Enumeration Date
08/06/2015
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
75-2616977-123 01 TX TRICARE
752616977180 01 TX TRICARE
352279902 05 TX
P01784015 01 TX RAIL ROAD MEDICARE
institution
Provider Business Practice Location Address Details
Address
703 S Fleishel Ave
City
State
Zip
75701-2015
Phone Number
903-606-2830
Fax Number
person
Provider Business Mailing Address Details
Address
703 S Fleishel Ave
City
State
Zip
75701-2015
Phone Number
903-606-2830
Fax Number
person
Provider's Taxonomy Details 1
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Nurse Practitioner
Speciality
Acute Care
Taxonomy
License No.
AP08445 (Louisiana)
Definition
Definition to come...
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