Provider Demographics
NPI:1669960886
Name:HUNTER, CINDY R (PA-C, RD)
Entity type:Individual
Prefix:
First Name:CINDY
Middle Name:R
Last Name:HUNTER
Suffix:
Gender:F
Credentials:PA-C, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7591 FERN AVE STE 1705
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-5749
Mailing Address - Country:US
Mailing Address - Phone:318-550-3398
Mailing Address - Fax:
Practice Address - Street 1:7591 FERN AVE STE 1705
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5749
Practice Address - Country:US
Practice Address - Phone:318-550-3398
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-23
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AM0700X
GALD004733133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered