Basic Information
| Provider Information | |||||||||
| NPI: | 1558552091 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TULL | ||||||||
| FirstName: | CINDRA | ||||||||
| MiddleName: | E. | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5681 | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 65801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4178310150 | ||||||||
| FaxNumber: | 4178653479 | ||||||||
| Practice Location | |||||||||
| Address1: | 440 E. TAMPA ST | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 65806 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4178310150 | ||||||||
| FaxNumber: | 4178653479 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2007 | ||||||||
| LastUpdateDate: | 01/28/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 142839 | MO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 427018908 | 05 | MO | MEDICAID |