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Individual

KRISTIE TIDRICK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
RN

Contact information

Practice address
1 WALTER SCHOLER DR, LAFAYETTE, IN 47909-6303
(765) 448-8000
Mailing address
1200 W WHITE RIVER BLVD, MUNCIE, IN 47303-4988
(877) 668-5621

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
28210200A
IN
363LF0000X
Family Nurse Practitioner
PENDING
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
PENDING
ANTHEM PIN NUMBER
IN
05
PENDING
IN
Enumeration date
01/08/2019
Last updated
02/26/2021
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