Provider Demographics
NPI:1912906421
Name:TIDWELL, SHARI P (FNP)
Entity Type:Individual
Prefix:MS
First Name:SHARI
Middle Name:P
Last Name:TIDWELL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:SHARI
Other - Middle Name:P
Other - Last Name:HEATHCOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:1445 PARR AVE
Mailing Address - Street 2:
Mailing Address - City:DYERSBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38024-3153
Mailing Address - Country:US
Mailing Address - Phone:731-286-6156
Mailing Address - Fax:731-286-6797
Practice Address - Street 1:1445 PARR AVE
Practice Address - Street 2:
Practice Address - City:DYERSBURG
Practice Address - State:TN
Practice Address - Zip Code:38024-3153
Practice Address - Country:US
Practice Address - Phone:731-286-6156
Practice Address - Fax:731-286-6797
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6331363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
3120511OtherBCBS OF TN
TN3902167Medicaid
TN3902167Medicaid
S79296Medicare UPIN