Provider Demographics
NPI:1902418940
Name:BURGESS, CYNTHIA M
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:M
Last Name:BURGESS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 262
Mailing Address - Street 2:
Mailing Address - City:KINCAID
Mailing Address - State:WV
Mailing Address - Zip Code:25119-0262
Mailing Address - Country:US
Mailing Address - Phone:304-640-0945
Mailing Address - Fax:
Practice Address - Street 1:93 LANG RD
Practice Address - Street 2:
Practice Address - City:PAGE
Practice Address - State:WV
Practice Address - Zip Code:25119
Practice Address - Country:US
Practice Address - Phone:304-640-0945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-20
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant