Provider Demographics
NPI:1598720625
Name:GLENN-BIRKHEAD, CYNTHIA DIANE (ARNP)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:DIANE
Last Name:GLENN-BIRKHEAD
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:DIANE
Other - Last Name:GLENN-BIRKHEAD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ARNP
Mailing Address - Street 1:10048 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:WHITESVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42378
Mailing Address - Country:US
Mailing Address - Phone:270-729-4777
Mailing Address - Fax:270-233-0202
Practice Address - Street 1:10015 MAIN ST
Practice Address - Street 2:
Practice Address - City:WHITESVILLE
Practice Address - State:KY
Practice Address - Zip Code:42378-9557
Practice Address - Country:US
Practice Address - Phone:270-233-1884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2848P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78028487Medicaid
KY78028487Medicaid