Active NPI
Nedra G Tidwell
- Child Intellectual and/or Developmental Disabilities Respite Care
- Azle, TX
National Provider Identifier
1790959252
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Child Intellectual and/or Developmental Disabilities Respite Care
- License
- 28761
- Practice address
- 7525 Portwood Rd
Azle, TX 76020-5835 - Phone
- (817) 444-5665
- Fax
- (817) 444-9115
- NPI assigned
- Apr 16, 2008
- Sex
- Female
- Sole proprietor
- Yes
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 | 28761 | TX | |
| Child Intellectual and/or Developmental Disabilities Respite Care | 385HR2060X | 28761 | TX | Primary |
Addresses
Primary practice location
7525 Portwood Rd
Azle, TX 76020-5835
Mailing address
7529 Portwood Rd
Azle, TX 76020
Phone (817) 444-5665
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 |
|---|---|---|---|
| 28761 | TX | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1208304000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1208304000000",
"number": "1790959252",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7529 PORTWOOD RD",
"city": "AZLE",
"state": "TX",
"postal_code": "76020",
"telephone_number": "817-444-5665",
"fax_number": "817-444-9115"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7525 PORTWOOD RD",
"city": "AZLE",
"state": "TX",
"postal_code": "760205835",
"telephone_number": "817-444-5665",
"fax_number": "817-444-9115"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TIDWELL",
"first_name": "NEDRA",
"middle_name": "G",
"name_prefix": "Mrs.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-04-16",
"last_updated": "2008-04-16",
"status": "A"
},
"taxonomies": [
{
"code": "164X00000X",
"taxonomy_group": "",
"desc": "Licensed Vocational Nurse",
"state": "TX",
"license": "28761",
"primary": false
},
{
"code": "385HR2060X",
"taxonomy_group": "",
"desc": "Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child",
"state": "TX",
"license": "28761",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Azle, TX
- Texas Health Harris Methodist Hospital Azle
- Texas Health Harris Methodist Hospital Azle
- Texas Health Harris Methodist Hospital Azle
- Texas Health Harris Methodist Hospital Azle
- Thomas L Reid PTPC
- Todays Dental, P.a.
- Kaitlin Tollison, LCSW-S
- Alfred Torres, LCDC
- Bichlien Jenny Tran, RPH
- Anne Freda Trapp, APRN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.