SHANNON TISDELL FNP NPI 1790384329

NPI Information

  • NPI: 1790384329
  • Provider Name: SHANNON TISDELL, FNP
  • Classification: Nurse Practitioner - 363LF0000X
  • Specialization: Family
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 6674 GOODMAN RD
    OLIVE BRANCH, MS
    ZIP 38654
  • Phone: (662) 985-7806

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NPI Details

Shannon Tisdell, FNP is a family nurse practitioner in Olive Branch, MS with 5 years of experience. Shannon Tisdell, FNP NPI is 1790384329. 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:

6674 GOODMAN RD
OLIVE BRANCH, MS
ZIP 38654-056
Phone: (662) 985-7806

The NPI 1790384329 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 following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.

  • Follow-up hospital inpatient care per day, typically 25 minutes (HCPCS:99232)

The enumeration date for this NPI number is 10/24/2020 and was last updated on 10/24/2020.

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 PractitionerFamily904149MISSISSIPPIYes
2363LF0000XNurse PractitionerFamily27722TENNESSEENo

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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