Katelyn Tidwell, PHARMD

Primary specialty

PharmacistTaxonomy code 183500000X

License

PS43999 Issued in FL

Practice address

688 Baldwin Ave
Defuniak Springs, FL 32435-2596

Phone

(850) 892-5612

NPI assigned

Feb 10, 2021

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

Credentials

Doctor of Pharmacy

State licenses

Practice roles

Locations

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

• Fisher Pharmacy, Inc

  • Community/Retail Pharmacy
  • Defuniak Springs, FL
  • NPI 1861532145
  NPD

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

{
    "created_epoch": "1612915200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612915200000",
    "number": "1497347496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "688 BALDWIN AVE",
            "city": "DEFUNIAK SPRINGS",
            "state": "FL",
            "postal_code": "324352596",
            "telephone_number": "850-892-5612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "688 BALDWIN AVE",
            "city": "DEFUNIAK SPRINGS",
            "state": "FL",
            "postal_code": "324352596",
            "telephone_number": "850-892-5612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIDWELL",
        "first_name": "KATELYN",
        "credential": "PHARMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-02-10",
        "last_updated": "2021-02-10",
        "certification_date": "2021-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "FL",
            "license": "PS43999",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• The Arc of Walton County, Inc.
• The Pathology Group of Northwest Florida PLLC
• The Vision Hub LLC (The Vision Hub at Defuniak Springs)
• Makayla M Thomasson, RBT
• Linda Jane Thornton, DDS
• Jo Ellen Tomlinson, OD
• Total Renal Care Inc (Defuniak Springs Dialysis)
• Julie Tran
• Triple E OT, Inc
• Arielle Turner

• Pharmacist in Defuniak Springs, FL
• Providers in Defuniak Springs, FL by specialty
• Pharmacist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2021; 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.