Provider Demographics
NPI:1477556397
Name:MCGLOTHLIN, CYNTHIA (WHNP)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:
Last Name:MCGLOTHLIN
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:MISS
Other - First Name:CYNTHIA
Other - Middle Name:
Other - Last Name:GROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:WHNP
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37662-0009
Mailing Address - Country:US
Mailing Address - Phone:423-857-2066
Mailing Address - Fax:423-857-2070
Practice Address - Street 1:350 STEELES RD
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-9532
Practice Address - Country:US
Practice Address - Phone:423-844-4925
Practice Address - Fax:423-844-4933
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2009-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN144476363LW0102X
VA0024165896363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010114497Medicaid
TN3499917Medicaid
Q27006Medicare UPIN
TN3499917Medicaid
TNP00291792Medicare PIN
TNC30809Medicare PIN
TN0281780003Medicare PIN
VA010114497Medicaid
TN0281780001Medicare PIN