Kristen Tidwell, MS, RD, LD, CNSC

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

DT80388 Issued in TX

Practice address

15 Veneto LN
Missouri City, TX 77459-1166

Phone

(281) 995-1323

NPI assigned

Jan 6, 2019

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX, DC2 enrollments

Enrollment records 2

Specialty

Registered Dietitian Or Nutrition Professional

Education

Other, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Privia Medical Group Gulf Coast PLLCGroup PAC ID 4688999022, 511 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kristen.tidwell.3@8042.direct.athenahealth.com

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.

• Privia Medical Group Gulf Coast, PLLC

  • Obstetrics & Gynecology Physician
  • Houston, TX
  • NPI 1578969465
  Medicare reassignment Care Compare group NPD
• Privia Medical Group West Texas, PLLC

  dba Abilene Diagnostic Clinic, PLLC

  • Specialist
  • Abilene, TX
  • NPI 1346242567
  Medicare reassignment NPD
• Privia Medical Group, LLC

  • Internal Medicine Physician
  • Arlington, VA
  • NPI 1013042480

  DC

  Medicare reassignment NPD
• Privia Medical Group Gulf Coast PLLC

  dba Express Pain and Urgent Care

  • Interventional Pain Medicine Physician
  • San Antonio, TX
  • NPI 1457167033
  NPD
• Privia Medical Group West Texas, PLLC

  dba Abilene Diagnostic Clinics

  • Podiatrist
  • Abilene, TX
  • NPI 1043725062
  NPD
• Privia Medical Group, LLC

  • Pain Medicine (Psychiatry & Neurology) Physician
  • Rockville, MD
  • NPI 1811715436
  NPD
• Privia Medical Group West Texas, PLLC

  • Pathology Specialist/Technologist
  • Abilene, TX
  • NPI 1760482665
  NPD (past)

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

{
    "created_epoch": "1546732800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1546732800000",
    "number": "1053884742",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 VENETO LN",
            "city": "MISSOURI CITY",
            "state": "TX",
            "postal_code": "774591166",
            "telephone_number": "281-995-1323"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 VENETO LN",
            "city": "MISSOURI CITY",
            "state": "TX",
            "postal_code": "774591166",
            "telephone_number": "281-995-1323"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIDWELL",
        "first_name": "KRISTEN",
        "credential": "MS, RD, LD, CNSC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-01-06",
        "last_updated": "2019-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "TX",
            "license": "DT80388",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Thompsonresidentalcare
• Vivien Yiyuan Thong
• Thrivefocus
• Thrivelight Wellness Corp. (Zion Healing Center of Sugar Land)
• Through Your Eyes Counseling Services, PLLC
• David Tien
• Jenifer Juanita Tillery, R.PH.
• Tilton Healthcare, Inc.
• Keriomi Timpson-Bey, LCSW
• Arlene Georgia Tinker, MD

• Registered Dietitian in Missouri City, TX
• Providers in Missouri City, TX by specialty
• Registered Dietitian in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.