Provider Demographics
NPI:1902843006
Name:TAYLOR, CYNTHIA N (FNP)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:N
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2144 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-2739
Mailing Address - Country:US
Mailing Address - Phone:573-776-6939
Mailing Address - Fax:
Practice Address - Street 1:2210 BARRON RD
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-1908
Practice Address - Country:US
Practice Address - Phone:573-778-9598
Practice Address - Fax:573-778-9581
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO89872363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO428607329Medicaid
S30218Medicare UPIN
MO428607329Medicaid