Provider Demographics
NPI:1962502526
Name:MUSGROVE, CINDY S (APN)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:S
Last Name:MUSGROVE
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5703 NIGHTHAWK RD
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72118-1734
Mailing Address - Country:US
Mailing Address - Phone:501-765-1006
Mailing Address - Fax:
Practice Address - Street 1:1612 EDISON AVE
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015-4630
Practice Address - Country:US
Practice Address - Phone:501-303-5650
Practice Address - Fax:501-303-5602
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA001032363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR136531758Medicaid
ARS55714Medicare UPIN
AR5U253Medicare ID - Type Unspecified