Provider Demographics
NPI:1578582441
Name:KUES, CYNTHIA L (ANP)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:L
Last Name:KUES
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 MASON RIDGE CENTER DR STE 300
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8512
Mailing Address - Country:US
Mailing Address - Phone:314-448-3791
Mailing Address - Fax:
Practice Address - Street 1:4600 MEMORIAL DR STE W1
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62226-5359
Practice Address - Country:US
Practice Address - Phone:618-233-3066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209003890363L00000X, 207RI0011X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP01024948OtherRAILROAD
IL209003890Medicaid
IL$$$$$$$$$001Medicaid
IL670940006Medicare PIN
IL$$$$$$$$$001Medicaid
K20400Medicare ID - Type Unspecified
P52743Medicare UPIN
IL596500022Medicare PIN