1396706180 NPI number — CYNTHIA T NELSON APN

Table of content: CYNTHIA T NELSON APN (NPI 1396706180)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396706180 NPI number — CYNTHIA T NELSON APN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NELSON
Provider First Name:
CYNTHIA
Provider Middle Name:
T
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396706180
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/27/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 21850
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOT SPRINGS
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
71903-1850
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-622-3979
Provider Business Mailing Address Fax Number:
501-622-3993

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ONE MERCY LANE,
Provider Second Line Business Practice Location Address:
SUITE 405
Provider Business Practice Location Address City Name:
HOT SPRINGS
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
71913-6441
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-622-3979
Provider Business Practice Location Address Fax Number:
501-622-3993
Provider Enumeration Date:
03/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  A01310 ANP , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: A01310 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 136146758 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 101596400 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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