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Individual

MR. TIMOTHY SCOTT TIDWELL II

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DNP, NP-C

Contact information

Practice address
12221 HEATHFIELD LN, OKLAHOMA CITY, OK 73173-7011
(918) 647-1648
Mailing address
12221 HEATHFIELD LN, OKLAHOMA CITY, OK 73173-7011
(918) 647-1648

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
101752
OK

Other

Enumeration date
06/02/2018
Last updated
06/02/2018
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