Provider Demographics
NPI:1811286305
Name:TINDALL, SHERRY (ANP)
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:
Last Name:TINDALL
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3550 MCKELVEY RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:MO
Mailing Address - Zip Code:63044-2527
Mailing Address - Country:US
Mailing Address - Phone:314-741-0911
Mailing Address - Fax:314-741-0501
Practice Address - Street 1:3550 MCKELVEY RD
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-2527
Practice Address - Country:US
Practice Address - Phone:314-741-0911
Practice Address - Fax:314-741-0501
Is Sole Proprietor?:No
Enumeration Date:2011-04-05
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209008717363LF0000X
MO2011006159363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1811286305Medicaid