MEDICARE: MIND & BODY WELLNESS, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	363LF0000X	Family Nurse Practitioner
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner
3	363LP2300X	Primary Care Nurse Practitioner

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134713159
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIND & BODY WELLNESS, PLLC

Provider Business Mailing Address
First Line	:	329 SILVER GROVE CHURCH RD
Second Line	:
City	:	ROCKINGHAM
State	:	NC
Zip	:	28379-6978
Country	:	US
Telephone Number	:	704-476-9144
Fax Number	:

Provider Business Practice Location Address
First Line	:	329 SILVER GROVE CHURCH RD
Second Line	:
City	:	ROCKINGHAM
State	:	NC
Zip	:	28379-6978
Country	:	US
Telephone Number	:	910-387-3840
Fax Number	:	704-703-9668

Authorized Official
Title or Position	:	OWNER
Name	:	LEISTEY TINDALL
Credential	:	PMHNP, FNP
Telephone Number	:	704-476-9144

Provider Enumeration Date	:	02/22/2021
Last Update Date	:	01/20/2026

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Directions to “MIND & BODY WELLNESS, PLLC ” Practice Location

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