| 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 |