1528215407 NPI number — CYNTHIA KUPSICK HONEYCUTT ANP-BC

Table of content: CYNTHIA KUPSICK HONEYCUTT ANP-BC (NPI 1528215407)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528215407 NPI number — CYNTHIA KUPSICK HONEYCUTT ANP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HONEYCUTT
Provider First Name:
CYNTHIA
Provider Middle Name:
KUPSICK
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ANP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NORTON
Provider Other First Name:
CYNTHIA
Provider Other Middle Name:
KUPSICK
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
ANP-BC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1528215407
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/24/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1420G US HIGHWAY 52 N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALBEMARLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28001-2622
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-982-0161
Provider Business Mailing Address Fax Number:
704-512-4838

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
105 YADKIN ST
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
ALBEMARLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28001-3449
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-982-0161
Provider Business Practice Location Address Fax Number:
704-512-4808
Provider Enumeration Date:
08/22/2008

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: 364SA2200X , with the licence number:  5004069 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: 152864 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: NC8170C . This is a "MEDICARE INDIVIDUAL PROVIDER NUMBER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 7005393 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: NP3299 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1528215407 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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