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

Shannon Tisdell, FNP

Individual provider Family Nurse Practitioner · NPI 1790384329

Shannon Tisdell, FNP is a Nurse Practitioner in Olive Branch, Mississippi. Qualified in 2020, 6 years ago. Practices with UT Regional One Physicians Inc, a 327-clinician group and accepts Medicare assignment. Licensed in Mississippi and Tennessee.

Years since qualifying
6
Licensed in
MS, TN
In the registry since
2020
Specialties on file
2
What do these letters mean?
FNP — Family Nurse Practitioner
A nurse practitioner who treats patients of all ages, much like a family doctor.

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Practice location Address checks out

6674 Goodman Rd
Olive Branch, MS 38654-7056
Phone: (662) 985-7806
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence 904149 (MS)
Family Nurse Practitioner Taxonomy 363LF0000X · Licence 27722 (TN)

Record details

NPI number1790384329
Entity typeIndividual (Type 1)
GenderFemale
Credentials FNP
Sole proprietorNo
NPI enumeratedOctober 24, 2020
Last updated in NPPESOctober 24, 2020
Certification dateOctober 24, 2020

Medicare enrollment

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

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2020 (6 years in practice)
Group practice Ut Regional One Physicians Inc — 327 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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