NPI | 1558774950 |
---|---|
Former Name | KERRIE ANN TIDWELL |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2083B0002X Preventive Medicine, Obesity Medicine (Licence: GA 89945) |
Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0101257908) |
207P00000X Emergency Medicine (Licence: MD D0079851) | |
207P00000X Emergency Medicine (Licence: GA 89945) | |
314000000X Skilled Nursing Facility (Licence: GA 89945) | |
Enumeration Date | 2014-06-04 |
Last Update Date | 2025-08-06 |