Anna Grace Tidmore

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

S5240 Issued in MS

Practice address

5960 Getwell Rd Ste 212D
Southaven, MS 38672-7320

Phone

(662) 228-0130

NPI assigned

Sep 9, 2024

Last updated

Sep 9, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Moore Speech Therapy, LLC

  dba Moore Pediatric Therapy

  • Speech-Language Pathologist
  • Southaven, MS
  • NPI 1780296525
  NPD (past)

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

{
    "created_epoch": "1725840000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725840000000",
    "number": "1407682362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2950 DOVE CV",
            "city": "HERNANDO",
            "state": "MS",
            "postal_code": "386327640",
            "telephone_number": "662-545-1006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5960 GETWELL RD STE 212D",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386727320",
            "telephone_number": "662-228-0130"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5740 Getwell Rd Bldg 9A",
            "address_purpose": "LOCATION",
            "city": "Southaven",
            "state": "MS",
            "postal_code": "386727360",
            "country_code": "US",
            "telephone_number": "901-302-8101",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TIDMORE",
        "first_name": "ANNA",
        "middle_name": "GRACE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-09-09",
        "last_updated": "2024-09-09",
        "certification_date": "2024-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MS",
            "license": "S5240",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elaine Allen Thompson, MD
• Kenneth Allan Thompson, M.D.
• Stanley Craig Thompson, MD
• Michelle A Thornton, PLPC
• Naganath Thota, M.D
• Dana Tidmore, FNP-C
• Sarada Tilton
• TMK Enterprises (Southern Grace Psychiatry)
• Kimberly Toler
• Susan M Tolley, ACNP

• Speech-Language Pathologist in Southaven, MS
• Providers in Southaven, MS by specialty
• Speech-Language Pathologist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 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.