Provider Demographics
NPI:1225164155
Name:MOOREHEAD, CYNTHIA KAY (RN)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:KAY
Last Name:MOOREHEAD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 SMITH MILL RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37334-6842
Mailing Address - Country:US
Mailing Address - Phone:931-433-3231
Mailing Address - Fax:931-438-1567
Practice Address - Street 1:1000 WASHINGTON ST W
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37334-2872
Practice Address - Country:US
Practice Address - Phone:931-433-3231
Practice Address - Fax:931-438-1567
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000067540163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse