Jennifer F Tidwell, CRNP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

1-129613 Issued in AL

Practice address

488 Saint Lukes Dr
Montgomery, AL 36117-7104

Phone

(334) 288-7808

Fax

(334) 288-8089

NPI assigned

Feb 7, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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.

• Children's Urgent Care, LLC

  • Urgent Care Clinic/Center
  • Birmingham, AL
  • NPI 1124541438

  Nurse Practitioner

  Medicare reassignment NPD
• Emergency Services of Montgomery PC

  • Emergency Medicine Physician
  • Prattville, AL
  • NPI 1528310323

  Nurse Practitioner

  Medicare reassignment NPD
• Montgomery Pediatric Assoc, P.a.

  • Pediatric Adolescent Medicine Physician
  • Montgomery, AL
  • NPI 1770532681
  NPD (past)
• River Valley Medical Center Family Clinic LLC

  • Rural Health Clinic/Center
  • Dardanelle, AR
  • NPI 1245437490
  NPD (past)

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

{
    "created_epoch": "1517961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609718400000",
    "number": "1205335999",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "448 SAINT LUKES DR",
            "city": "MONTGOMERY",
            "state": "AL",
            "postal_code": "361177104",
            "telephone_number": "334-288-7808",
            "fax_number": "334-288-8089"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "488 SAINT LUKES DR",
            "city": "MONTGOMERY",
            "state": "AL",
            "postal_code": "361177104",
            "telephone_number": "334-288-7808",
            "fax_number": "334-288-8089"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIDWELL",
        "first_name": "JENNIFER",
        "middle_name": "F",
        "name_prefix": "Mrs.",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-02-07",
        "last_updated": "2021-01-04",
        "certification_date": "2021-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AL",
            "license": "1-129613",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "AL",
            "license": "1-129613",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David R. Thrasher, M.D.
• Three Folds Care Inc.
• Thrive Family Chiropractic LLC (Thrive Family Chiropractic)
• Vaishali Thudi, MD
• Marilyn Loretta Tidwell -Shoemaker, NURSE PRACTITIONER
• Patrick R Tidwell, PH.D, LMFT
• Brittany Till, PHARMD
• Tiffy Tillman
• Victoria Nicole Tillman
• Timothy W Morrow MD PC

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2021; 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.