Provider Demographics
NPI:1134545890
Name:TYNDALL, KAYLA BREN RAYNOR (PA)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:BREN RAYNOR
Last Name:TYNDALL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 TILGHMAN DR
Mailing Address - Street 2:
Mailing Address - City:DUNN
Mailing Address - State:NC
Mailing Address - Zip Code:28334-5533
Mailing Address - Country:US
Mailing Address - Phone:910-892-1333
Mailing Address - Fax:
Practice Address - Street 1:104 TILGHMAN DR
Practice Address - Street 2:
Practice Address - City:DUNN
Practice Address - State:NC
Practice Address - Zip Code:28334-5533
Practice Address - Country:US
Practice Address - Phone:910-892-1333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-05
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-04767363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant