Individual
SHANNON TISDELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
6674 GOODMAN RD, OLIVE BRANCH, MS 38654-7056
(662) 985-7806
Mailing address
7587 WISTERIA DR, OLIVE BRANCH, MS 38654-6982
(662) 313-7520
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
27722
TN
363LF0000X
Family Nurse Practitioner
Primary
904149
MS
Other
Enumeration date
10/24/2020
Last updated
10/24/2020
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