Individual
MS. JENNIFER BAREFOOT TIDWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
140 CHARLOIS BLVD, WINSTON SALEM, NC 27103-1522
(336) 716-4131
(336) 713-0328
Mailing address
100 KIMEL FOREST DR, WINSTON SALEM, NC 27103-6074
(336) 716-0238
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
5013567
NC
363LF0000X
Family Nurse Practitioner
F07202295
NC
Other
Enumeration date
07/30/2020
Last updated
09/19/2022
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