Provider Demographics
NPI:1851332217
Name:ROBERTSON, CINDY LUKE (CFNP)
Entity Type:Individual
Prefix:MRS
First Name:CINDY
Middle Name:LUKE
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:MRS
Other - First Name:CINDY
Other - Middle Name:ANN
Other - Last Name:ROBERTSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CFNP
Mailing Address - Street 1:3700 N. FRONTAGE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39701-8408
Mailing Address - Country:US
Mailing Address - Phone:662-240-9999
Mailing Address - Fax:662-241-5451
Practice Address - Street 1:3700 N. FRONTAGE RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39701-8408
Practice Address - Country:US
Practice Address - Phone:662-240-9999
Practice Address - Fax:662-241-5451
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR545538363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS500001665Medicare ID - Type Unspecified
MSS72323Medicare UPIN