Provider Demographics
NPI:1619919842
Name:AHEARN, CYNTHIA SUSAN (FAMILY NURSE PRACTIT)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:SUSAN
Last Name:AHEARN
Suffix:
Gender:F
Credentials:FAMILY NURSE PRACTIT
Other - Prefix:
Other - First Name:CINDY
Other - Middle Name:
Other - Last Name:AHEARN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNPC
Mailing Address - Street 1:PO BOX 914
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-1189
Mailing Address - Country:US
Mailing Address - Phone:800-640-3451
Mailing Address - Fax:
Practice Address - Street 1:2011 N COLLINS BLVD STE 607
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-2636
Practice Address - Country:US
Practice Address - Phone:800-640-3451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP231849363L00000X
TX251413363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXQ28713Medicare UPIN