Active NPI
Jamie Renee Tidwell, LDH
- Dental Hygienist
- Clinton, IN
National Provider Identifier
1477049989
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Hygienist
- License
- 13005947A
- Practice address
- 1792 E State Road 163
Clinton, IN 47842-7327 - Phone
- (765) 828-3241
- Fax
- (765) 828-3243
- NPI assigned
- Jul 9, 2018
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Dental Hygienist | 124Q00000X | 13005947A | IN | Primary |
Addresses
Primary practice location
1792 E State Road 163
Clinton, IN 47842-7327
Mailing address
1792 E State Road 163
Clinton, IN 47842-7327
Phone (765) 828-3241
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 |
|---|---|---|---|
| 13005947A | IN | MD | Dental Hygienist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1531094400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1779235200000",
"number": "1477049989",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1792 E STATE ROAD 163",
"city": "CLINTON",
"state": "IN",
"postal_code": "478427327",
"telephone_number": "765-828-3241",
"fax_number": "765-828-3243"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1792 E STATE ROAD 163",
"city": "CLINTON",
"state": "IN",
"postal_code": "478427327",
"telephone_number": "765-828-3241",
"fax_number": "765-828-3243"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TIDWELL",
"first_name": "JAMIE",
"middle_name": "RENEE",
"credential": "LDH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-07-09",
"last_updated": "2026-05-20",
"certification_date": "2026-05-20",
"status": "A"
},
"taxonomies": [
{
"code": "124Q00000X",
"taxonomy_group": "",
"desc": "Dental Hygienist",
"state": "IN",
"license": "13005947A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clinton, IN
- Angela Deann Stewart, P.T.
- Nicole Suzette Hall Stilianos, N.P.
- Melissa Ann Stinnett, LSW
- The Happy Tooth, LLC
- The Health and Hospital Corporation of Marion County
- Union Associated Physicians Clinic, LLC
- Union Associated Physicians Clinic, LLC
- Union Hospital Clinton
- Union Hospital Inc
- Union Hospital Inc
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.