Marilyn Loretta Tidwell -Shoemaker, NURSE PRACTITIONER

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

95013184 Issued in CA

Practice address

233 Winton Blount Loop
Montgomery, AL 36117-3507

Phone

(334) 350-5648

NPI assigned

Dec 5, 2019

Sex

Female

Sole proprietor

No

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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

{
    "created_epoch": "1575504000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705363200000",
    "number": "1144867409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "233 WINTON BLOUNT LOOP",
            "city": "MONTGOMERY",
            "state": "AL",
            "postal_code": "361173507",
            "telephone_number": "334-239-2622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "233 WINTON BLOUNT LOOP",
            "city": "MONTGOMERY",
            "state": "AL",
            "postal_code": "361173507",
            "telephone_number": "334-350-5648"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIDWELL -SHOEMAKER",
        "first_name": "MARILYN",
        "middle_name": "LORETTA",
        "name_prefix": "Dr.",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-12-05",
        "last_updated": "2024-01-16",
        "certification_date": "2024-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "95013184",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ellen Colley Thrash, CRNP
• David R. Thrasher, M.D.
• Three Folds Care Inc.
• Thrive Family Chiropractic LLC (Thrive Family Chiropractic)
• Vaishali Thudi, MD
• Jennifer F Tidwell, CRNP
• Patrick R Tidwell, PH.D, LMFT
• Brittany Till, PHARMD
• Tiffy Tillman
• Victoria Nicole Tillman

• Psychiatric/Mental Health Nurse Practitioner in Montgomery, AL
• Providers in Montgomery, AL by specialty
• Psychiatric/Mental Health Nurse Practitioner in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.