FAMILY PRACTICE CLINIC, PC
NPI 1023380474
Nurse Practitioner - Family in Dyersburg, TN
About Family Practice Clinic, Pc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
FAMILY PRACTICE CLINIC, PC (NPI 1023380474) is a healthcare organization registered as a family in Dyersburg, Tennessee and active in the NPI registry since February 2012. The organization holds a CLIA Waiver certificate valid through July 7, 2027 and lists Shari P Tidwell, Owner/provider, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Family Practice Clinic, Pc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
Medicare enrollment records show 1 clinician reassigns Medicare billing to Family Practice Clinic, PC, which bills Medicare for the services this clinician delivers.
Clinician (1)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 44D0962574
Family Practice Clinic PC · Dyersburg, TNFrequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Family Practice Clinic, PC's NPI number?
The NPI number for Family Practice Clinic, PC is 1023380474. It was assigned to this organization in the NPPES registry on February 1, 2012.
Where is Family Practice Clinic, PC located?
Family Practice Clinic, PC is located at 1445 Parr Ave, Dyersburg, TN 38024. The listed phone number is (731) 286-6156.
What is Family Practice Clinic, PC's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.
Is Family Practice Clinic, PC enrolled in Medicare?
Yes. Family Practice Clinic, PC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Family Practice Clinic, PC?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Nurse Practitioner) reassigns their Medicare billing to Family Practice Clinic, PC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Family Practice Clinic, PC hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 44D0962574) is associated with this NPI, valid through July 7, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
When was this NPI record last updated?
The NPPES record for Family Practice Clinic, PC was last updated on November 20, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Family Practice Clinic, Pc · NPI 1023380474
Family organization in Dyersburg, Tennessee. Organization record, active in the CMS NPPES registry since February 1, 2012.
## Identity
- **NPI:** 1023380474 (Entity type: Organization)
- **Enumerated:** February 1, 2012
- **Primary specialty:** Nurse Practitioner - Family · taxonomy 363LF0000X
- **Organization subpart:** No
- **Authorized official:** Shari Tidwell, OWNER/PROVIDER
## Practice location
- **Address:** 1445 PARR AVE, Dyersburg, TN 38024-3153
- **Phone:** (731) 286-6156 · **Fax:** (731) 286-6797
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 1 clinician (Nurse Practitioner) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** November 20, 2025
- **CLIA laboratory certificates:** 1 on file
---
Source: [NPI Profile](https://npiprofile.com/npi/1023380474) · Data from the CMS NPPES public registry.