Randy Tidwell, APN

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

13982 Issued in TN

Practice address

421 N Broadway
Portland, TN 37148-1750

Phone

(615) 323-1020

Fax

(615) 323-1021

NPI assigned

Feb 8, 2009

Sex

Male

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

Enrolled in TN

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Interoperability endpoints

• Direct secure messaging: portlandfamilycare@ppdxdirect.com

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

{
    "created_epoch": "1234051200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1343952000000",
    "number": "1164661674",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 507",
            "address_2": "421 N BROADWAY",
            "city": "PORTLAND",
            "state": "TN",
            "postal_code": "371480507",
            "telephone_number": "615-323-1020",
            "fax_number": "615-323-1021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "421 N BROADWAY",
            "city": "PORTLAND",
            "state": "TN",
            "postal_code": "371481750",
            "telephone_number": "615-323-1020",
            "fax_number": "615-323-1021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIDWELL",
        "first_name": "RANDY",
        "credential": "APN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-02-08",
        "last_updated": "2012-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "13982",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tennessee CVS Pharmacy LLC
• The Meadows at Halltown, Inc.
• The Mobile Car Wash Corp
• Tidwell Family Ventures LLC
• Emily Tidwell, NP
• Jennifer Leigh Toney, RN
• Top Flight Medical Group LLC
• Truth in Counseling
• Tucker Anesthesia Services, LLC
• Gloria Jean Turner

• Family Nurse Practitioner in Portland, TN
• Providers in Portland, TN by specialty
• Family Nurse Practitioner in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2012; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.