Provider Demographics
NPI:1346676277
Name:CUSON, CYNTHIA LYNN (FNP)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:LYNN
Last Name:CUSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:CYNTHIA
Other - Middle Name:LYNN
Other - Last Name:POOLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:201 SIGMA DR
Mailing Address - Street 2:STE 100
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29486-7715
Mailing Address - Country:US
Mailing Address - Phone:843-761-2815
Mailing Address - Fax:843-899-4723
Practice Address - Street 1:100 SPRINGHALL DR
Practice Address - Street 2:
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-5335
Practice Address - Country:US
Practice Address - Phone:843-572-8201
Practice Address - Fax:843-797-8491
Is Sole Proprietor?:No
Enumeration Date:2013-09-24
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18484363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP2653Medicaid
SCSC21057555Medicare PIN
SCSC21057819Medicare PIN
SCSC21058798Medicare PIN
SCSC21057522Medicare PIN
SCSC21056882Medicare PIN
SCNP2653Medicaid
SCSC21056834Medicare PIN
SCSC21057499Medicare PIN
SCSC21056868Medicare PIN
SCSC21057006Medicare PIN
SCSC21055281Medicare PIN
SCSC2105Medicare UPIN
SCSC21055282Medicare PIN
SCSC21057126Medicare PIN
SCSC21055277Medicare PIN