Zachary Tisdale
Zachary Tisdale is a Nurse Practitioner in De Kalb, Mississippi. Qualified in 2025, 1 year ago. Practices with Bonita Emergency Group LLC, a 27-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Mississippi.
- Years since qualifying
- 1
- Licensed in
- MS
- In the registry since
- 2026
Practice location Address checks out
14365 Highway 16 WDe Kalb, MS 39328-7974
Phone: (769) 486-1000
Show map & directions
Directions in Google Maps · Apple Maps · OpenStreetMap
Pin is approximate — placed at the ZIP-code centre, not the exact door.
Additional practice locations (1)
- 1314 19th Ave, Meridian, MS 39301-4116 — (601) 483-0011
Specialties & licences
| Nurse Practitioner (primary) | Taxonomy 363L00000X · Licence 907900 (MS) |
|---|
Record details
| NPI number | 1730048794 |
|---|---|
| Entity type | Individual (Type 1) |
| Gender | Male |
| Sole proprietor | No |
| NPI enumerated | January 16, 2026 |
| Last updated in NPPES | January 16, 2026 |
| Certification date | January 16, 2026 |
Medicare enrollment
| Medicare specialty | NURSE PRACTITIONER |
|---|---|
| Medical school | OTHER |
| Graduated | 2025 (1 years in practice) |
| Group practice | Bonita Emergency Group Llc — 27 clinicians |
| Accepts Medicare assignment | Yes — accepts the Medicare-approved amount |
| Practice locations | 2 on file with Medicare |