Provider Demographics
NPI:1740361369
Name:TYNDALL, HEATHER ERIN (PA)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:ERIN
Last Name:TYNDALL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:ERIN
Other - Last Name:CRONKHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1850 W ARLINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-5704
Mailing Address - Country:US
Mailing Address - Phone:252-413-6740
Mailing Address - Fax:252-752-6600
Practice Address - Street 1:744 AIRPORT ROAD
Practice Address - Street 2:
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28504-8800
Practice Address - Country:US
Practice Address - Phone:252-523-0026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-00617363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1653MOtherBCBS
NC8102516Medicaid
NC2759273AMedicare PIN