Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Lacy Rebaka Tisdale, NP-C

Individual provider Family Nurse Practitioner · NPI 1033517768

Lacy Rebaka Tisdale, NP-C is a Nurse Practitioner in Jackson, Tennessee. Qualified in 2014, 12 years ago. Practices with Fast Pace Medical Clinic PLLC, a 738-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Arkansas and Tennessee.

Years since qualifying
12
Licensed in
AR, TN
In the registry since
2014
Specialties on file
2
What do these letters mean?
NP-C — Nurse Practitioner, Certified
A nurse practitioner certified by the AANP.

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Practice location Address checks out

2054 S Highland Ave
Jackson, TN 38301-7741
Phone: (731) 499-8708
Fax: (731) 499-8709
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 6806 Mammoth Cv, Pine Bluff, AR 71603-4304 — (870) 413-2203

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence 25492 (TN)
Family Nurse Practitioner Taxonomy 363LF0000X · Licence A004241 (AR)

Record details

NPI number1033517768
Entity typeIndividual (Type 1)
GenderFemale
Credentials NP-C
Sole proprietorNo
NPI enumeratedDecember 11, 2014
Last updated in NPPESApril 9, 2021
Certification dateMarch 19, 2021

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2014 (12 years in practice)
Group practice Fast Pace Medical Clinic Pllc — 738 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

Other providers in Jackson