Provider Demographics
NPI:1669409272
Name:TYNDALL, KAREN Y (PHD)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:Y
Last Name:TYNDALL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7512
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73083-7512
Mailing Address - Country:US
Mailing Address - Phone:405-945-4999
Mailing Address - Fax:
Practice Address - Street 1:3400 NW EXPRESSWAY
Practice Address - Street 2:SUITE 312
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4493
Practice Address - Country:US
Practice Address - Phone:405-945-4999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK719103T00000X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK731547098-002OtherBC/BS