Provider Demographics
NPI:1124379375
Name:KINDALL, TAVELL LAMAR (FNP-BC)
Entity Type:Individual
Prefix:MR
First Name:TAVELL
Middle Name:LAMAR
Last Name:KINDALL
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 LUKE DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203-6769
Mailing Address - Country:US
Mailing Address - Phone:318-342-8339
Mailing Address - Fax:
Practice Address - Street 1:115 LUKE DR
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71203-6769
Practice Address - Country:US
Practice Address - Phone:318-342-8339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-27
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP07001363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily