Active NPI
Melanie Tisdale
- Licensed Vocational Nurse
- Fresno, CA
National Provider Identifier
1770785164
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Vocational Nurse
- License
- 178081
- Practice address
- 4441 E Kings Canyon Rd
Fresno, CA 93750-1805 - Phone
- (559) 600-9171
- NPI assigned
- Jun 5, 2007
- Last updated
- May 17, 2021
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Vocational Nurse | 164X00000X | 178681 | CA | |
| Licensed Vocational Nurse | 164X00000X | 178081 | CA | Primary |
Addresses
Primary practice location
4441 E Kings Canyon Rd
Fresno, CA 93750-1805
Mailing address
PO Box 11867
Correctional Health
Fresno, CA 93775-1867
Phone (559) 442-2404
Other practice location 1
1225 M St
Correctional Health, 2nd Floor
Fresno, CA 93721-1805
Phone (559) 442-2404
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 |
|---|---|---|---|
| 178081 | CA | MD | Licensed Vocational Nurse |
| 178681 | CA | MD | Licensed Vocational Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| County of Fresno | Past | Accepting new patients | |
| County of Fresno | Past | Accepting new patients |
Organizations & group practices 2
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1181001600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1621209600000",
"number": "1770785164",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 11867",
"address_2": "CORRECTIONAL HEALTH",
"city": "FRESNO",
"state": "CA",
"postal_code": "937751867",
"telephone_number": "559-442-2404",
"fax_number": "559-442-5277"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4441 E KINGS CANYON RD",
"city": "FRESNO",
"state": "CA",
"postal_code": "937501805",
"telephone_number": "559-600-9171"
}
],
"practiceLocations": [
{
"address_1": "1225 M St",
"address_2": "Correctional Health, 2nd Floor",
"address_purpose": "LOCATION",
"city": "Fresno",
"state": "CA",
"postal_code": "937211805",
"country_code": "US",
"telephone_number": "559-442-2404",
"fax_number": "559-442-5277",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "TISDALE",
"first_name": "MELANIE",
"name_prefix": "Ms.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-06-05",
"last_updated": "2021-05-17",
"certification_date": "2021-05-17",
"status": "A"
},
"taxonomies": [
{
"code": "164X00000X",
"taxonomy_group": "",
"desc": "Licensed Vocational Nurse",
"state": "CA",
"license": "178681",
"primary": false
},
{
"code": "164X00000X",
"taxonomy_group": "",
"desc": "Licensed Vocational Nurse",
"state": "CA",
"license": "178081",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fresno, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 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.