Healthcare Provider Details

I. General information

NPI: 1093466971
Provider Name (Legal Business Name): LONI TYNDALL HEGARTY FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2022
Last Update Date: 01/03/2025
Certification Date: 01/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6602 KNIGHTDALE BLVD STE 102
KNIGHTDALE NC
27545-6526
US

IV. Provider business mailing address

5221 PARAMOUNT PKWY STE 220
MORRISVILLE NC
27560-5490
US

V. Phone/Fax

Practice location:
  • Phone: 919-747-5210
  • Fax:
Mailing address:
  • Phone: 984-215-4111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5015604
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5015604
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: