Provider Demographics
NPI:1326588492
Name:TINDALL, LEISTEY (FNP-BC, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:LEISTEY
Middle Name:
Last Name:TINDALL
Suffix:
Gender:F
Credentials:FNP-BC, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 SILVER GROVE CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:ROCKINGHAM
Mailing Address - State:NC
Mailing Address - Zip Code:28379-6978
Mailing Address - Country:US
Mailing Address - Phone:910-387-7300
Mailing Address - Fax:704-703-9668
Practice Address - Street 1:329 SILVER GROVE CHURCH RD
Practice Address - Street 2:
Practice Address - City:ROCKINGHAM
Practice Address - State:NC
Practice Address - Zip Code:28379-6978
Practice Address - Country:US
Practice Address - Phone:910-387-7300
Practice Address - Fax:704-703-9668
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-08
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5009344363LF0000X, 363LP0808X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty