Evelyn Jean Tidwell, M ED, LAT, RMT

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

AT1486 Issued in TX

Practice address

319 Pond View Pass
Buda, TX 78610-3613

Phone

(210) 573-4165

NPI assigned

Mar 29, 2014

Last updated

Mar 29, 2014By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Education

State licenses

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

{
    "created_epoch": "1396051200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1396051200000",
    "number": "1821416710",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "319 POND VIEW PASS",
            "city": "BUDA",
            "state": "TX",
            "postal_code": "786103613",
            "telephone_number": "210-573-4165"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "319 POND VIEW PASS",
            "city": "BUDA",
            "state": "TX",
            "postal_code": "786103613",
            "telephone_number": "210-573-4165"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIDWELL",
        "first_name": "EVELYN",
        "middle_name": "JEAN",
        "credential": "M ED, LAT, RMT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-03-29",
        "last_updated": "2014-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "TX",
            "license": "AT1486",
            "primary": true
        },
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "TX",
            "license": "MT030247",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Athletic Trainer in Buda, TX
• Providers in Buda, TX by specialty
• Athletic Trainer in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 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.