Jessi Blackstock Tidwell, CRNP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

1-162142 Issued in AL

Practice address

2904 Mall Rd
Florence, AL 35630-1641

Phone

(256) 768-5350

Fax

(949) 695-4340

NPI assigned

Jan 3, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in AL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Evolve Behavioral Health LLCGroup PAC ID 9032559521, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Evolve Behavioral Health, LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Florence, AL
  • NPI 1316708993
  Medicare reassignment Care Compare group NPD Authorized official
• Shoals Health Group LLC

  • Internal Medicine Physician
  • Muscle Shoals, AL
  • NPI 1073851630

  Nurse Practitioner

  Medicare reassignment NPD
• Drayer Physical Therapy Alabama LLC

  • Physical Therapy Clinic/Center
  • Northport, AL
  • NPI 1417593625
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1578009600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1746057600000",
    "number": "1013556356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2904 MALL RD",
            "city": "FLORENCE",
            "state": "AL",
            "postal_code": "356301641",
            "telephone_number": "256-394-0880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2904 MALL RD",
            "city": "FLORENCE",
            "state": "AL",
            "postal_code": "356301641",
            "telephone_number": "256-768-5350",
            "fax_number": "949-695-4340"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIDWELL",
        "first_name": "JESSI",
        "middle_name": "BLACKSTOCK",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-01-03",
        "last_updated": "2025-05-01",
        "certification_date": "2025-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AL",
            "license": "1-162142",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "AL",
            "license": "1-162142",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "AL",
            "license": "1-162142",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Perin Keith Thompson, MD
• Rebekah Grace Thompson, RN
• Tanya Leeann Thornton, RN
• Thoughtful Journey Counseling, LLC
• Three Oaks Pharmacy LLC
• Timothy Dale Ashley MD PC
• McKenzie Tittle
• Christina Tolliver
• Tomsik Eyecare, Inc
• Roberta Lee Tomsik, OD

• Nurse Practitioner in Florence, AL
• Providers in Florence, AL by specialty
• Nurse Practitioner in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.