Provider Demographics
NPI:1750300273
Name:MASHBURN, CYNTHIA M (APRN, BC)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:M
Last Name:MASHBURN
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1995 HIGHWAY 51 S
Mailing Address - Street 2:SUITE 101
Mailing Address - City:COVINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38019-3635
Mailing Address - Country:US
Mailing Address - Phone:731-635-1874
Mailing Address - Fax:
Practice Address - Street 1:1995 HIGHWAY 51 S
Practice Address - Street 2:SUITE 101
Practice Address - City:COVINGTON
Practice Address - State:TN
Practice Address - Zip Code:38019-3635
Practice Address - Country:US
Practice Address - Phone:901-476-7371
Practice Address - Fax:901-476-7372
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12055363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN12055OtherSTATE LICENSE