Healthcare Provider Details

I. General information

NPI: 1326588492
Provider Name (Legal Business Name): LEISTEY TINDALL FNP-BC, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2017
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3603 W STAGE COACH TRL
SHELBY NC
28150-9598
US

IV. Provider business mailing address

329 SILVER GROVE CHURCH RD
ROCKINGHAM NC
28379-6978
US

V. Phone/Fax

Practice location:
  • Phone: 910-387-3840
  • Fax: 704-703-9668
Mailing address:
  • Phone: 910-387-7300
  • Fax: 704-703-9668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5009344
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number5009344
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5009344
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: