STACY RENEE TIDWELL APRN NPI 1265746820

NPI Information

  • NPI: 1265746820
  • Provider Name: STACY RENEE TIDWELL, APRN
  • Classification: Nurse Practitioner - 363LW0102X
  • Specialization: Women's Health
  • Entity Type: Individual
  • Address: 4618 WILLOW RIDGE WAY
    ROGERS, AR
    ZIP 72758
  • Phone: (479) 587-1700

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NPI Details

Stacy Renee Tidwell, APRN is a women's health nurse practitioner in Rogers, AR. Stacy Renee Tidwell, APRN NPI is 1265746820. 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:

4618 WILLOW RIDGE WAY
ROGERS, AR
ZIP 72758-089
Phone: (479) 587-1700

The enumeration date for this NPI number is 8/5/2010 and was last updated on 4/4/2023.

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
1363LF0000XNurse PractitionerFamilyA003421ARKANSASNo
2363LW0102XNurse PractitionerWomen's HealthA003421ARKANSASYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1184226758MEDICAIDARKANSAS
21265746820MEDICAIDMISSOURI
3200301950AMEDICAIDOKLAHOMA

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: 3/30/2025

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