Provider Demographics
NPI:1013981083
Name:PACKER, CINDY H (CNS)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:H
Last Name:PACKER
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4127
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24015-0127
Mailing Address - Country:US
Mailing Address - Phone:940-981-9394
Mailing Address - Fax:540-344-7154
Practice Address - Street 1:19 BRIAR KNOLL CT
Practice Address - Street 2:STE 1
Practice Address - City:FISHERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22939-2635
Practice Address - Country:US
Practice Address - Phone:540-949-0955
Practice Address - Fax:540-949-8377
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024165889364S00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA085354MOtherOPTIMA BEHAVORIAL
VA172650OtherANTHEM BEHAVORIAL
VA5596863OtherFIRST HEALTH
VA010093317OtherVIRGINIA PREMIER
VA010093317Medicaid
VA010093317OtherVIRGINIA PREMIER
VA5596863OtherFIRST HEALTH
VA006100A62Medicare ID - Type Unspecified