Provider Demographics
NPI:1669843793
Name:STOCK, CYNTHIA DIANE (FNP-C)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:DIANE
Last Name:STOCK
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 S BUSINESS HIGHWAY 13
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:64067-1515
Mailing Address - Country:US
Mailing Address - Phone:660-259-2440
Mailing Address - Fax:660-251-0524
Practice Address - Street 1:608 MISSOURI ST
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:MO
Practice Address - Zip Code:64096
Practice Address - Country:US
Practice Address - Phone:660-493-2262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-15
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016006905363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO41820053Medicaid
CO460144YXQFMedicare PIN