Provider Demographics
NPI:1083625305
Name:VINCENT, CYNTHIA TALBOTT (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:TALBOTT
Last Name:VINCENT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:93 SKIDMORE LANE
Mailing Address - Street 2:
Mailing Address - City:SUTTON
Mailing Address - State:WV
Mailing Address - Zip Code:26601
Mailing Address - Country:US
Mailing Address - Phone:304-765-3480
Mailing Address - Fax:304-765-3286
Practice Address - Street 1:93 SKIDMORE LANE
Practice Address - Street 2:
Practice Address - City:SUTTON
Practice Address - State:WV
Practice Address - Zip Code:26601
Practice Address - Country:US
Practice Address - Phone:304-765-3480
Practice Address - Fax:304-765-3286
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2012-08-15
Deactivation Date:2007-09-28
Deactivation Code:
Reactivation Date:2010-09-09
Provider Licenses
StateLicense IDTaxonomies
WV01207363A00000X
NC101354363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant