Provider Demographics
NPI:1164466280
Name:COLLUM, CYNTHIIA (RNFA, BSN)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIIA
Middle Name:
Last Name:COLLUM
Suffix:
Gender:F
Credentials:RNFA, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5420 MEDICAL PARKWAY DR
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-4622
Mailing Address - Country:US
Mailing Address - Phone:903-793-8966
Mailing Address - Fax:903-792-1722
Practice Address - Street 1:5420 MEDICAL PARKWAY DR
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-4622
Practice Address - Country:US
Practice Address - Phone:903-793-8966
Practice Address - Fax:903-792-1722
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX234077363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical