| Lacy Rebaka Tisdale, NP-C | |
|
2054 S Highland Ave, Jackson, TN 38301-7741 | |
| (731) 499-8708 | |
| (731) 499-8709 |
| Full Name | Lacy Rebaka Tisdale |
|---|---|
| Gender | Female |
| Speciality | Nurse Practitioner |
| Experience | 10 Years |
| Location | 2054 S Highland Ave, Jackson, Tennessee |
| Accepts Medicare Assignments | Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033517768 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 363LF0000X | Nurse Practitioner - Family | A004241 (Arkansas) | Secondary |
| 363LF0000X | Nurse Practitioner - Family | 25492 (Tennessee) | Primary |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Fast Pace Medical Clinic Pllc | 5395881841 | 510 |
| Entity Name | Fast Pace Medical Clinic Pllc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1134452865 PECOS PAC ID: 5395881841 Enrollment ID: O20091014000112 |
| Entity Name | Truhealth, Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1063843951 PECOS PAC ID: 2163653478 Enrollment ID: O20140331001471 |
| Mailing Address | Practice Location Address |
|---|---|
| Lacy Rebaka Tisdale, NP-C 42 Cabin Creek Dirve, Jackson, TN 38305 Ph: (870) 413-2203 | Lacy Rebaka Tisdale, NP-C 2054 S Highland Ave, Jackson, TN 38301-7741 Ph: (731) 499-8708 |
Katherine E Wyatt, A.P.R.N. Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 145 Innovation Dr, Jackson, TN 38305 Phone: 731-422-0213 Fax: 731-660-8301 | |
Amy K Lawrence, FNP Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 2863 Highway 45 Byp, Jackson, TN 38305 Phone: 731-422-0213 Fax: 731-660-8380 | |
Lauren Williams, Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 1047 Union University Dr, Jackson, TN 38305 Phone: 731-256-0035 | |
Anna K Younger, APRN Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 145 Innovation Dr, Jackson, TN 38305 Phone: 731-422-0213 Fax: 731-660-8301 | |
Kirsten Siler, Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 27a Medical Center Drive, Jackson, TN 38301 Phone: 731-541-3310 | |
Stephanie Pool, APRN Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 36 Pemberton Cv, Jackson, TN 38305 Phone: 731-394-1145 Fax: 844-374-0233 | |
Kimberlie A Simpson, APRN, FNP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 23 Independence Ln, Jackson, TN 38305 Phone: 731-617-1483 |