Provider Demographics
NPI:1679962641
Name:DR. KAREN A. TIDMORE
Entity type:Organization
Organization Name:DR. KAREN A. TIDMORE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY PRACTICE
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:TIDMORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-967-7716
Mailing Address - Street 1:1811 SHARP SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37398-4659
Mailing Address - Country:US
Mailing Address - Phone:931-967-7716
Mailing Address - Fax:
Practice Address - Street 1:1811 SHARP SPRINGS RD
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37398-4659
Practice Address - Country:US
Practice Address - Phone:931-967-7716
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-14
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDO 0000000400207Q00000X
TNAPN0000015232363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0058092OtherBCBS
TN4441604OtherCIGNA
TN0058092OtherBLUE CARE TENNCARE
TN0058092OtherBCBS