Jessica King Tidwell, AGACNP-BC - Medicare Nurse Practitioner in Tyler, TX

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Jessica King Tidwell, AGACNP-BC is a medicare enrolled "Nurse Practitioner - Acute Care" in Tyler, Texas. Her current practice location is 703 S Fleishel Ave, Ste 5000, Tyler, Texas. You can reach out to her office (for appointments etc.) via phone at (903) 606-2830.

Jessica King Tidwell is licensed to practice in Texas (license number AP130723) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1629454160.

Contact Information

Jessica King Tidwell, AGACNP-BC
703 S Fleishel Ave, Ste 5000,
Tyler, TX 75701-2015
(903) 606-2830
Not Available

Map and Direction




Provider's Profile

Full NameJessica King Tidwell
GenderFemale
SpecialityNurse Practitioner - Acute Care
Location703 S Fleishel Ave, Tyler, Texas
Accepts Medicare AssignmentsMedicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.
  NPI Data:
  • NPI Number: 1629454160
  • Provider Enumeration Date: 08/06/2015
  • Last Update Date: 10/22/2018
  Medicare PECOS Information:
  • PECOS PAC ID: 6901113471
  • Enrollment ID: I20150916000085

Medical Identifiers

Medical identifiers for Jessica King Tidwell such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1629454160NPI-NPPES
75-2616977-123OtherTXTRICARE
752616977180OtherTXTRICARE
352279902MedicaidTX
P01784015OtherTXRAIL ROAD MEDICARE

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
363LA2100XNurse Practitioner - Acute Care AP08445 (Louisiana)Secondary
363LA2100XNurse Practitioner - Acute Care AP130723 (Texas)Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Jessica King Tidwell allows following entities to bill medicare on her behalf.
Entity NameLouisiana State University Health Sciences Center
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1417992249
PECOS PAC ID: 6103730908
Enrollment ID: O20031208000275
Entity NameWkmc Cardiovascular Consultants
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1801205802
PECOS PAC ID: 0941420061
Enrollment ID: O20141013000521
Entity NameLsu Health Sciences Center Shreveport Faculty Group Practice
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1013374222
PECOS PAC ID: 4082902721
Enrollment ID: O20161012000307

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Jessica King Tidwell is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Jessica King Tidwell, AGACNP-BC
1501 Kings Highway, Attn: Leisa Oglesby (med Sch Rm 1-201),
Shreveport, LA 71103-4228

Ph: (318) 675-4881		Jessica King Tidwell, AGACNP-BC
703 S Fleishel Ave, Ste 5000,
Tyler, TX 75701-2015

Ph: (903) 606-2830

Reviews and Comments


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Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

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