LACY REBAKA TISDALE NP-C NPI 1033517768

NPI Information

NPI: 1033517768
Provider Name: LACY REBAKA TISDALE, NP-C
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Individual

Specialization: Family

Organization: FAST PACE MEDICAL CLINIC PLLC

PECOS Registration: Yes

Address:
2054 S HIGHLAND AVE
JACKSON, TN
ZIP 38301
Phone: (731) 499-8708
Get Directions

Lacy Rebaka Tisdale, NP-C is a family nurse practitioner in Jackson, TN with 10 years of experience. Lacy Rebaka Tisdale, NP-C NPI is 1033517768. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

2054 S HIGHLAND AVE
JACKSON, TN
ZIP 38301-741
Phone: (731) 499-8708
Fax: (731) 499-8709

The NPI 1033517768 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 12/11/2014 and was last updated on 4/9/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LF0000X	Nurse Practitioner	Family	25492	TENNESSEE	Yes
2	363LF0000X	Nurse Practitioner	Family	A004241	ARKANSAS	No

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.

« Previous NPI

Next NPI »