Provider Demographics
NPI:1952481830
Name:PHILLIPS, CYNTHIA C (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:C
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2424 COLGATE DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-5314
Mailing Address - Country:US
Mailing Address - Phone:910-486-8654
Mailing Address - Fax:910-483-9572
Practice Address - Street 1:200 FORSYTHE ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-5426
Practice Address - Country:US
Practice Address - Phone:910-485-0700
Practice Address - Fax:910-483-9572
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC101338363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCQ19503Medicare UPIN