Provider Demographics
NPI:1841033222
Name:TYNDALL, STEPHANIE D (FNP-C APRN MSN-E)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:D
Last Name:TYNDALL
Suffix:
Gender:F
Credentials:FNP-C APRN MSN-E
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6705 HWY 258 S
Mailing Address - Street 2:
Mailing Address - City:DEEP RUN
Mailing Address - State:NC
Mailing Address - Zip Code:28525-9653
Mailing Address - Country:US
Mailing Address - Phone:252-560-0413
Mailing Address - Fax:252-624-0428
Practice Address - Street 1:324 N QUEEN ST
Practice Address - Street 2:
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28501-4932
Practice Address - Country:US
Practice Address - Phone:252-522-9800
Practice Address - Fax:252-624-0428
Is Sole Proprietor?:No
Enumeration Date:2024-06-14
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5020228364SF0001X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health