Provider Demographics
NPI:1306302500
Name:TIDWELL, ASHLYN MARIE (ASHLYN)
Entity type:Individual
Prefix:
First Name:ASHLYN
Middle Name:MARIE
Last Name:TIDWELL
Suffix:
Gender:F
Credentials:ASHLYN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1333 W WASHINGTON ST
Mailing Address - Street 2:TARLETON MSAT DEPARTMENT
Mailing Address - City:STEPHENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76401
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5813 EMILY CT
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:TX
Practice Address - Zip Code:76065-6929
Practice Address - Country:US
Practice Address - Phone:469-716-9181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-13
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program