Provider Demographics
NPI:1306833215
Name:ASHCRAFT, CYNTHIA K (MD)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:K
Last Name:ASHCRAFT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 402330
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-2330
Mailing Address - Country:US
Mailing Address - Phone:479-709-7399
Mailing Address - Fax:479-709-7053
Practice Address - Street 1:1501 S WALDRON RD
Practice Address - Street 2:STE 100
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-2574
Practice Address - Country:US
Practice Address - Phone:479-709-7337
Practice Address - Fax:479-709-7461
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC6785208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100077910AMedicaid
AR114495001Medicaid
AR114495001Medicaid
AR5AB48Medicare PIN