Individual
BARRY SIDWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
620 SKYLINE DR, JACKSON, TN 38301-3923
(731) 343-2486
Mailing address
559 LAKEWOOD DR E, JACKSON, TN 38305-6217
(731) 343-2486
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
28237
TN
Other
Enumeration date
12/24/2020
Last updated
12/24/2020
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