Individual
MR. JIMMY LEE TISDALE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APRN, FNP-C
Contact information
Practice address
7117 W WILSHIRE BLVD, OKLAHOMA CITY, OK 73132-5575
(405) 470-1224
(405) 217-0063
Mailing address
7117 W WILSHIRE BLVD, OKLAHOMA CITY, OK 73132-5575
(405) 470-1224
(405) 217-0063
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R80659
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200500020A
—
OK
05
—
200599270A
—
OK
Enumeration date
06/14/2013
Last updated
07/31/2025
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