Provider Demographics
NPI:1619957685
Name:FAULKNER, CINDY B (PA C)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:B
Last Name:FAULKNER
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1008 FELDSPAR COURT
Mailing Address - Street 2:
Mailing Address - City:HANNA
Mailing Address - State:WY
Mailing Address - Zip Code:82327
Mailing Address - Country:US
Mailing Address - Phone:307-325-6596
Mailing Address - Fax:307-325-6597
Practice Address - Street 1:1008 FELDSPAR COURT
Practice Address - Street 2:
Practice Address - City:HANNA
Practice Address - State:WY
Practice Address - Zip Code:82327
Practice Address - Country:US
Practice Address - Phone:307-325-6596
Practice Address - Fax:307-325-6597
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY262363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYP00074038OtherRAILROAD MEDICARE
312330OtherBCBS
WY116832100Medicaid
WY9811Medicare ID - Type Unspecified
WYP00074038OtherRAILROAD MEDICARE