1700898368 NPI number — CYNTHIA R WARE APRN

Table of content: CYNTHIA R WARE APRN (NPI 1700898368)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700898368 NPI number — CYNTHIA R WARE APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WARE
Provider First Name:
CYNTHIA
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN
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:
1700898368
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/25/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1080
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BURKESVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42717-1080
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-858-6655
Provider Business Mailing Address Fax Number:
270-858-4027

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2615 FLAHERTY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EKRON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40117-8805
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
844-435-0900
Provider Business Practice Location Address Fax Number:
270-858-4029
Provider Enumeration Date:
08/12/2006

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: 363LF0000X , with the licence number:  3002839 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000000232256 . This is a "ANTHEM" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 1164657 . This is a "PASSPORT" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 15560077 . This is a "CAQH" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 78008125 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200399710 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2439863000 . This is a "PASSPORT ADVANTAGE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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