Provider Demographics
NPI:1225013063
Name:BYNDOM, MARY LINDA (FNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:LINDA
Last Name:BYNDOM
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2846 WHITENER ST
Mailing Address - Street 2:APT B4
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701-8314
Mailing Address - Country:US
Mailing Address - Phone:573-334-2586
Mailing Address - Fax:
Practice Address - Street 1:2130 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MO
Practice Address - Zip Code:63755-1644
Practice Address - Country:US
Practice Address - Phone:573-243-2154
Practice Address - Fax:573-243-3400
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MORN116998363L00000X
TN20518363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO428312409Medicaid