Provider Demographics
NPI:1154502136
Name:TINDALL, BRENDA CELESTE (MBA,RD,LD,CDE,BC-ADM)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:CELESTE
Last Name:TINDALL
Suffix:
Gender:F
Credentials:MBA,RD,LD,CDE,BC-ADM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2999 REYNOLDS LN
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75033-2693
Mailing Address - Country:US
Mailing Address - Phone:817-475-1275
Mailing Address - Fax:817-572-9902
Practice Address - Street 1:2999 REYNOLDS LN
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-2693
Practice Address - Country:US
Practice Address - Phone:817-475-1275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-19
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX817434133V00000X
TXDT05337133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX610654OtherMEDICARE INDIVIDUAL NO.