Individual
FRANK TISDALE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
336 S JEFFERSON, NEOSHO, MO 64850
(417) 455-4200
(417) 455-4314
Mailing address
PO BOX 3810, JOPLIN, MO 64803
(417) 455-4200
(417) 455-4314
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
076343
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100049170A
—
OK
05
—
100283450B
—
KS
01
—
124503
ANTHEM
MO
05
—
428647325
—
MO
01
—
P00248188
RR MEDICARE
—
Enumeration date
05/05/2006
Last updated
04/12/2011
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