Individual
SHELLY D TIDWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
REGISTERED NURSE
Contact information
Practice address
1011 HONOR HEIGHTS DR, MUSKOGEE, OK 74401-1318
(918) 577-4015
Mailing address
18627 W 33RD ST S, HASKELL, OK 74436-8844
(918) 804-1624
Taxonomy
Speciality
Code
Description
License number
State
163WR0400X
Rehabilitation Registered Nurse
Primary
R0107941
OK
Other
Enumeration date
06/02/2025
Last updated
06/02/2025
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