Healthcare Provider Details

I. General information

NPI: 1366250920
Provider Name (Legal Business Name): AMBER TYNDAL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2024
Last Update Date: 12/27/2024
Certification Date: 12/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83 W COLT SQUARE DR
FAYETTEVILLE AR
72703-2814
US

IV. Provider business mailing address

83 W COLT SQUARE DR
FAYETTEVILLE AR
72703-2814
US

V. Phone/Fax

Practice location:
  • Phone: 479-935-1458
  • Fax:
Mailing address:
  • Phone: 479-935-1458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberR105502
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: