Provider Demographics
NPI:1629097217
Name:CUNNINGHAM, PATRICIA ANN (PMH-NP,BC)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:ANN
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:PMH-NP,BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 CRAGGY VISTA DR
Mailing Address - Street 2:
Mailing Address - City:SWANNANOA
Mailing Address - State:NC
Mailing Address - Zip Code:28778-6213
Mailing Address - Country:US
Mailing Address - Phone:828-298-1308
Mailing Address - Fax:
Practice Address - Street 1:47 CRAGGY VISTA DR
Practice Address - Street 2:
Practice Address - City:SWANNANOA
Practice Address - State:NC
Practice Address - Zip Code:28778-6213
Practice Address - Country:US
Practice Address - Phone:828-298-1308
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC119856363LP0808X
NYF400627-1363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6113090Medicaid