STACY RENEE TIDWELL APRN
NPI 1265746820
Nurse Practitioner - Women's Health in Rogers, AR

Q: What is Stacy Tidwell's NPI number?

The NPI number for Stacy Tidwell is 1265746820. It was assigned to this individual provider in the NPPES registry on August 5, 2010.

Q: What is Stacy Tidwell's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Women's Health, with taxonomy code 363LW0102X.

Q: When was this NPI record last updated?

The NPPES record for Stacy Tidwell was last updated on April 4, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years 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.

Active since August 05, 2010

4618 WILLOW RIDGE WAY, ROGERS, AR 72758(479) 587-1700 Get Directions Write a Review

NPPES record last updated: April 4, 2023. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Apr 4, 2023, Mar 30, 2020, Aug 29, 2019 and 2 more (5 updates tracked since 2017).

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About Stacy Renee Tidwell Aprn NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

STACY RENEE TIDWELL APRN (NPI 1265746820) is an individual women's health provider in Rogers, Arkansas, licensed in Arkansas (A003421) and active in the NPI registry since August 2010.

NPPES Registry Identity

NPI1265746820

Entity TypeIndividualFemale

Primary Taxonomy363LW0102X

Provider Legal NameSTACY RENEE TIDWELLCredential: APRN

Location Address4618 WILLOW RIDGE WAYRogers, AR 72758-8089

Mailing Address4618 Willow Ridge WayRogers, AR 72758-8089

Phone(479) 587-1700

Sole ProprietorNo

Enumeration DateAugust 5, 2010

Last NPPES UpdateApril 4, 20235 updates tracked since enumeration

NPPES CertifiedNovember 15, 2022

✔ NPI 1265746820 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse Practitioner · Women's HealthPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LW0102X

License✔ Licensed in AR · A003421

Also ListedNurse Practitioner · FamilyTaxonomy 363LF0000X · License A003421 (AR)

4618 WILLOW RIDGE WAY, Rogers, AR 72758

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Other Identifiers 3

Medicaid184226758AR

Medicaid1265746820MO

Medicaid200301950AOK

Frequently 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 Stacy Tidwell's NPI number?

The NPI number for Stacy Tidwell is 1265746820. It was assigned to this individual provider in the NPPES registry on August 5, 2010.

Where is Stacy Tidwell located?

Stacy Tidwell practices at 4618 Willow Ridge Way, Rogers, AR 72758. The listed phone number is (479) 587-1700.

What is Stacy Tidwell's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Women's Health, with taxonomy code 363LW0102X.

When was this NPI record last updated?

The NPPES record for Stacy Tidwell was last updated on April 4, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years 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.