Provider Demographics
NPI:1013098326
Name:SMITH, CYNTHIA JEAN (PC-C)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:JEAN
Last Name:SMITH
Suffix:
Gender:F
Credentials:PC-C
Other - Prefix:MRS
Other - First Name:CYNTHIA
Other - Middle Name:JEAN
Other - Last Name:CULP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:8903 NORTHWOOD PARK CIR
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-8596
Mailing Address - Country:US
Mailing Address - Phone:206-650-1406
Mailing Address - Fax:
Practice Address - Street 1:2550 DENALI ST
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-2783
Practice Address - Country:US
Practice Address - Phone:907-375-8787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT51534363A00000X
ID1791363A00000X
AK155344363A00000X
WAPA10005082363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7549CUOtherBSWA
WA8497562Medicaid
WA0225526OtherLIWA
WA8497562Medicaid
WA0225526OtherLIWA