Provider Demographics
NPI:1609368075
Name:TINDLE, RANDALL EDWARD (NP FNP)
Entity Type:Individual
Prefix:MR
First Name:RANDALL
Middle Name:EDWARD
Last Name:TINDLE
Suffix:
Gender:M
Credentials:NP FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 OTTAWA RD
Mailing Address - Street 2:
Mailing Address - City:NEODESHA
Mailing Address - State:KS
Mailing Address - Zip Code:66757-1897
Mailing Address - Country:US
Mailing Address - Phone:620-325-2611
Mailing Address - Fax:
Practice Address - Street 1:2600 OTTAWA RD
Practice Address - Street 2:
Practice Address - City:NEODESHA
Practice Address - State:KS
Practice Address - Zip Code:66757-1897
Practice Address - Country:US
Practice Address - Phone:620-325-2611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-01
Last Update Date:2018-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS58-78231-072363LF0000X
KS5878231072363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty