Provider Demographics
NPI:1457466336
Name:ROUNTREE, CYNTHIA ELAINE (PA-C)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:ELAINE
Last Name:ROUNTREE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6801 DIXIE HWY
Mailing Address - Street 2:SUITE 130
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40258-3913
Mailing Address - Country:US
Mailing Address - Phone:502-895-8970
Mailing Address - Fax:502-895-8971
Practice Address - Street 1:3920 DUTCHMANS LN
Practice Address - Street 2:SUITE 310
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4702
Practice Address - Country:US
Practice Address - Phone:502-895-8970
Practice Address - Fax:502-895-8971
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA758363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100038650Medicaid
KY7100038650Medicaid