Provider Demographics
NPI:1386643146
Name:CULP, CYNTHIA RAY (FNP)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:RAY
Last Name:CULP
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1199 N MACAILE WAY
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-6919
Mailing Address - Country:US
Mailing Address - Phone:208-938-5680
Mailing Address - Fax:208-938-5679
Practice Address - Street 1:951 E PLAZA DR
Practice Address - Street 2:SUITE NUMBER 110
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-6566
Practice Address - Country:US
Practice Address - Phone:208-938-5680
Practice Address - Fax:208-938-5679
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-14
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDN-20880 NP-365363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID805112500Medicaid
ID805112500Medicaid
ID1341883Medicare ID - Type Unspecified