Individual
ZACHARY TISDALE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
14365 HIGHWAY 16 W, DE KALB, MS 39328-7974
(769) 486-1000
Mailing address
36 MELISSA LOOP, PETAL, MS 39465-6303
(601) 550-0784
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
907900
MS
Other
Enumeration date
01/16/2026
Last updated
01/16/2026
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