Provider Demographics
NPI:1326034778
Name:CUNNINGHAM, KANDI LYNN (ARNP-CNP)
Entity Type:Individual
Prefix:MS
First Name:KANDI
Middle Name:LYNN
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:ARNP-CNP
Other - Prefix:MS
Other - First Name:KANDI
Other - Middle Name:FAULKS
Other - Last Name:CUNNINGHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP-CNP
Mailing Address - Street 1:1200 E PECAN ST
Mailing Address - Street 2:
Mailing Address - City:ALTUS
Mailing Address - State:OK
Mailing Address - Zip Code:73521-6141
Mailing Address - Country:US
Mailing Address - Phone:580-379-6100
Mailing Address - Fax:580-379-6109
Practice Address - Street 1:1200 E PECAN ST
Practice Address - Street 2:
Practice Address - City:ALTUS
Practice Address - State:OK
Practice Address - Zip Code:73521-6141
Practice Address - Country:US
Practice Address - Phone:580-379-6100
Practice Address - Fax:580-379-6109
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0044356363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100125470CMedicaid
OK100125470BMedicaid
500005037OtherRAILROAD MEDICARE
OK100125470AMedicaid