Jamall Tidwell, MHPP

Primary specialty

Case Manager/Care CoordinatorTaxonomy code 171M00000X

Practice address

829 Halbert St
Malvern, AR 72104-2607

Phone

(501) 332-4400

NPI assigned

Feb 25, 2014

Sex

Male

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

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

{
    "created_epoch": "1393286400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1393286400000",
    "number": "1477978690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29 ROSS AVENUE",
            "city": "ANTOINE",
            "state": "AR",
            "postal_code": "71922",
            "telephone_number": "870-379-2374"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "829 HALBERT ST",
            "city": "MALVERN",
            "state": "AR",
            "postal_code": "721042607",
            "telephone_number": "501-332-4400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIDWELL",
        "first_name": "JAMALL",
        "credential": "MHPP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-02-25",
        "last_updated": "2014-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dylan Paul Thaxton, M.D.
• The Crossing at Malvern
• Theraputic Family Services
• Pamela J Thomas, MHPP
• Julie A Thompson, COTA/L
• Tilley Diagnostic Clinic
• Absalom H Tilley, M.D.
• Tisha R. Jenkins, LCSW P.a.
• Makayla Tolliver
• Jasmine Traylor

• Case Manager/Care Coordinator in Malvern, AR
• Providers in Malvern, AR by specialty
• Case Manager/Care Coordinator in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2014; 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.