Provider Demographics
NPI:1093391724
Name:TIDWELL, MORGEN ASTON (NP-C)
Entity Type:Individual
Prefix:
First Name:MORGEN
Middle Name:ASTON
Last Name:TIDWELL
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:339 WALKER CHAPEL PLZ STE 109
Mailing Address - Street 2:
Mailing Address - City:FULTONDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35068-3402
Mailing Address - Country:US
Mailing Address - Phone:205-250-6502
Mailing Address - Fax:205-250-6003
Practice Address - Street 1:6150 US HIGHWAY 43
Practice Address - Street 2:
Practice Address - City:GUIN
Practice Address - State:AL
Practice Address - Zip Code:35563-3529
Practice Address - Country:US
Practice Address - Phone:205-468-2754
Practice Address - Fax:205-468-3664
Is Sole Proprietor?:No
Enumeration Date:2021-03-23
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-150866363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily