Provider Demographics
NPI:1093155673
Name:DOUGHTY, CYNTHIA KATHLEEN (MSN, CNP)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:KATHLEEN
Last Name:DOUGHTY
Suffix:
Gender:F
Credentials:MSN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2691 SAWBURY BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-4582
Mailing Address - Country:US
Mailing Address - Phone:614-553-7601
Mailing Address - Fax:614-553-7604
Practice Address - Street 1:2691 SAWBURY BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-4582
Practice Address - Country:US
Practice Address - Phone:614-553-7601
Practice Address - Fax:614-553-7604
Is Sole Proprietor?:No
Enumeration Date:2013-06-27
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.288485-COA 1363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0086421Medicaid