Tidwell, Stacy Renee

Tidwell, Stacy Renee is an individual health care provider with primary practice located at 4618 Willow Ridge Way , Rogers AR 72758-8089. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Family, Physician Assistants & Advanced Practice Nursing Providers / Women's Health. Physician Assistants & Advanced Practice Nursing Providers / Women's Health is her primary health care specialty. Tidwell, Stacy Renee can be contacted via phone (479) 587-1700.

Contact Information

Primary practice address
4618 Willow Ridge Way Rogers AR 72758-8089
Phone: (479) 587-1700
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X A003421 Arkansas
Physician Assistants & Advanced Practice Nursing Providers / Women's Health 363LW0102X A003421 Arkansas

Profile Details

NPI number 1265746820
LBN Legal business name Tidwell, Stacy Renee
Credentials Advanced Practice Registered Nurse (APRN)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 5th, 2010
Last updated Apr 4th, 2023 - about last year

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

Request for update

Identifiers

StateTypeNumberIssuer
All States NPI 1265746820 NPPES
Arkansas MEDICAID 184226758
Arkansas MEDICAID 1265746820
Arkansas MEDICAID 200301950A

Popular Providers