Healthcare Provider Details

I. General information

NPI: 1073675211
Provider Name (Legal Business Name): KAREN Y TYNDALL PH D P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 NW EXPRESSWAY ST SUITE 312
OKLAHOMA CITY OK
73112-4493
US

IV. Provider business mailing address

PO BOX 7512
EDMOND OK
73083-7512
US

V. Phone/Fax

Practice location:
  • Phone: 405-945-4999
  • Fax:
Mailing address:
  • Phone: 405-945-4999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number719
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number719
License Number StateOK

VIII. Authorized Official

Name: DR. KAREN Y TYNDALL
Title or Position: PRESIDENT
Credential: PH D
Phone: 405-945-4999