MEDICARE: LEISTEY TINDALL FNP-BC, PMHNP-BC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP2300X	Primary Care Nurse Practitioner	5009344	NC
2	363LF0000X	Family Nurse Practitioner	5009344	NC
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	5009344	NC

General Provider Information

NPI Number	:	1326588492
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEISTEY TINDALL FNP-BC, PMHNP-BC

Provider Business Mailing Address
First Line	:	329 SILVER GROVE CHURCH RD
Second Line	:
City	:	ROCKINGHAM
State	:	NC
Zip	:	28379-6978
Country	:	US
Telephone Number	:	910-387-7300
Fax Number	:	704-703-9668

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/08/2017
Last Update Date	:	01/20/2026

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