Provider Demographics
NPI:1942537121
Name:CUNNINGHAM HULSEY, CARON LYNN (CTR)
Entity Type:Individual
Prefix:MRS
First Name:CARON
Middle Name:LYNN
Last Name:CUNNINGHAM HULSEY
Suffix:
Gender:F
Credentials:CTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1618 EXCELSIOR RD
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:72936-5106
Mailing Address - Country:US
Mailing Address - Phone:479-597-0022
Mailing Address - Fax:479-314-1708
Practice Address - Street 1:1618 EXCELSIOR RD
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:AR
Practice Address - Zip Code:72936-5106
Practice Address - Country:US
Practice Address - Phone:479-597-0022
Practice Address - Fax:479-314-1708
Is Sole Proprietor?:No
Enumeration Date:2009-11-10
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2008137171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor