Larry E. Tidyman, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

343 Issued in NE

Practice address

1313 N Cheyenne St
Benkelman, NE 69021-3074

Phone

(308) 423-2151

Fax

(308) 423-2217

NPI assigned

Oct 6, 2006

Last updated

Sep 1, 2010By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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

{
    "created_epoch": "1160092800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1283299200000",
    "number": "1972690345",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 710",
            "city": "BENKELMAN",
            "state": "NE",
            "postal_code": "690210710",
            "telephone_number": "308-423-2151",
            "fax_number": "308-423-2217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1313 N CHEYENNE ST",
            "city": "BENKELMAN",
            "state": "NE",
            "postal_code": "690213074",
            "telephone_number": "308-423-2151",
            "fax_number": "308-423-2217"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIDYMAN",
        "first_name": "LARRY",
        "middle_name": "E.",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-06",
        "last_updated": "2010-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NE",
            "license": "343",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF NE",
            "identifier": "37814",
            "state": "NE"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2287458901",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alisha Shapley
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• Bryson Lee Smith
• Lori L Stonehocker, D.O.
• Jammie Thomas
• Tigers Pharmacy Inc (Benkelman Pharmacy)
• Shelby Lynn Vavra
• Laken Marae Vrbas, APRN
• Brandy Lynn Wallin, NP
• David G Younger, M.D

• Medical Physician Assistant in Benkelman, NE
• Providers in Benkelman, NE by specialty
• Medical Physician Assistant in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2010; 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.