Provider Demographics
NPI:1952598211
Name:CARPENTER, CYNTHIA MOORE (APN)
Entity type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:MOORE
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:APN
Other - Prefix:MRS
Other - First Name:CYNTHIA
Other - Middle Name:MOORE
Other - Last Name:CARPENTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APN
Mailing Address - Street 1:1 CHILDRENS WAY # 512-03
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72202-3500
Mailing Address - Country:US
Mailing Address - Phone:501-364-1479
Mailing Address - Fax:501-364-3186
Practice Address - Street 1:1 CHILDRENS WAY # 512-03
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72202-3500
Practice Address - Country:US
Practice Address - Phone:501-364-1479
Practice Address - Fax:501-364-3186
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA03028 ANP363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5V127Medicare PIN