Dana Tidmore, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

907549 Issued in MS

Practice address

3964 Goodman Rd E Ste 128
Southaven, MS 38672-6494

Phone

(622) 655-0456

NPI assigned

Jul 1, 2025

Last updated

Jul 1, 2025By the provider in NPPES

Sex

Female

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1751328000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1751328000000",
    "number": "1467341636",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3624 FLAT ROCK DR",
            "city": "HERNANDO",
            "state": "MS",
            "postal_code": "386324445"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3964 GOODMAN RD E STE 128",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386726494",
            "telephone_number": "622-655-0456"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIDMORE",
        "first_name": "DANA",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-07-01",
        "last_updated": "2025-07-01",
        "certification_date": "2025-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "907549",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kenneth Allan Thompson, M.D.
• Stanley Craig Thompson, MD
• Michelle A Thornton, PLPC
• Naganath Thota, M.D
• Anna Grace Tidmore
• Sarada Tilton
• TMK Enterprises (Southern Grace Psychiatry)
• Kimberly Toler
• Susan M Tolley, ACNP
• Total Quality Trans Care LLC

• Family Nurse Practitioner in Southaven, MS
• Providers in Southaven, MS by specialty
• Family Nurse Practitioner in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2025; 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.