Active NPI
Mark Dustin Tidwell
- Behavior Analyst
- Albuquerque, NM
National Provider Identifier
1285921999
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 504368441
- Practice address
- 1218 Griegos Rd NW
Albuquerque, NM 87107 - Phone
- (505) 345-8471
- NPI assigned
- Jul 1, 2011
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | 504368441 | NM | Primary |
Addresses
Primary practice location
1218 Griegos Rd NW
Albuquerque, NM 87107
Mailing address
1218 Griegos Road North West
Hogares
Albuquerque, NM 87107
Phone (505) 345-8471
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 |
|---|---|---|---|
| 504368441 | NM | MD | Behavioral Analyst |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1309478400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1309478400000",
"number": "1285921999",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1218 GRIEGOS ROAD NORTH WEST",
"address_2": "HOGARES",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "87107",
"telephone_number": "505-345-8471"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1218 GRIEGOS RD NW",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "87107",
"telephone_number": "505-345-8471"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TIDWELL",
"first_name": "MARK",
"middle_name": "DUSTIN",
"name_prefix": "Mr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-07-01",
"last_updated": "2011-07-01",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "NM",
"license": "504368441",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Albuquerque, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.