Individual
MRS. KAYLA KIZZIAH TIDWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
3316 HIGHWAY 280, ALEXANDER CITY, AL 35010-3369
(256) 329-7100
Mailing address
1034 S TALLASSEE ST, DADEVILLE, AL 36853-1844
(256) 825-9900
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
1-145314
AL
Other
Enumeration date
04/09/2018
Last updated
12/26/2020
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