Individual
PAUL TIMOTHY TIDMORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
2210 SUTHERLAND AVE STE 110, KNOXVILLE, TN 37919-2337
(865) 525-4333
(865) 374-2203
Mailing address
460 MEDICAL PARK DR STE 106, LENOIR CITY, TN 37772-5782
(865) 988-4452
(865) 988-6293
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
14982
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1523332
—
TN
Enumeration date
06/02/2010
Last updated
04/24/2024
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