Active NPI
Lelon Darwin Tidwell, RNFA
- Registered Nurse First Assistant
- Burleson, TX
National Provider Identifier
1225205677
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse First Assistant
- License
- 436290
- Practice address
- 11801 South Fwy
Burleson, TX 76028-7021 - Phone
- (817) 293-9110
- NPI assigned
- May 14, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse First Assistant | 163WR0006X | 436290 | TX | Primary |
Addresses
Primary practice location
11801 South Fwy
Burleson, TX 76028-7021
Mailing address
PO Box 11219
Fort Worth, TX 76110-0219
Phone (817) 294-7444
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 436290 | Other | TX | RN LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 436290 | TX | MD | Registered Nurse First Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1210723200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1210723200000",
"number": "1225205677",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 11219",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761100219",
"telephone_number": "817-294-7444"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11801 SOUTH FWY",
"city": "BURLESON",
"state": "TX",
"postal_code": "760287021",
"telephone_number": "817-293-9110"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TIDWELL",
"first_name": "LELON",
"middle_name": "DARWIN",
"credential": "RNFA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-05-14",
"last_updated": "2008-05-14",
"status": "A"
},
"taxonomies": [
{
"code": "163WR0006X",
"taxonomy_group": "",
"desc": "Registered Nurse, Registered Nurse First Assistant",
"state": "TX",
"license": "436290",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RN LICENSE",
"identifier": "436290",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Burleson, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.