| NPI | 1629454160 |
|---|---|
| Former Name | JESSICA KING TIDWELL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: LA AP08445) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX AP130723) |
| Enumeration Date | 2015-08-06 |
| Last Update Date | 2025-02-11 |