Jacalyn R Tidwell

NPI #1093316457 in Tulsa, Oklahoma

Provider Information

NPI Number: 1093316457
Entity Type: Individual
Name: Jacalyn R Tidwell
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Peer Specialist
Enumeration Date: Nov 3, 2020
Last Updated: Dec 10, 2021

Practice Location

Address: 5310 E 31ST ST STE 600
City: Tulsa
State: Oklahoma
ZIP Code: 74135-5018
Phone: (918) 587-9471

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Peer Specialist	175T00000X	Primary

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