Jonta Delisa Tidwell

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Practice address

3026 18TH St S
Fargo, ND 58103-6716

Phone

(480) 286-8603

NPI assigned

Jul 1, 2020

Sex

Female

Sole proprietor

Yes

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": "1593561600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1593561600000",
    "number": "1912524273",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3026 18TH ST S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581036716",
            "telephone_number": "480-286-8603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3026 18TH ST S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581036716",
            "telephone_number": "480-286-8603"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIDWELL",
        "first_name": "JONTA",
        "middle_name": "DELISA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-07-01",
        "last_updated": "2020-07-01",
        "certification_date": "2020-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brenda K Thurlow, MD
• Ashleigh Nicole Thurn
• Michael Thurn, OTR/L
• Jenna Thurston, LMSW
• Mia Tickel
• Hallie M Tiffany, APRN, CNP
• Robert R Tight, MD
• Eugene Joseph Tilchen, M.D.
• Janet K Tillisch, MD
• Jennifer A Tillisch, LAC

• Home Health Agency in Fargo, ND
• Providers in Fargo, ND by specialty
• Home Health Agency in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2020; 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.