Provider Demographics
NPI:1982748265
Name:WILLIAMS, CYNTHIA RENEE' (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:RENEE'
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:MRS
Other - First Name:CYNTHIA
Other - Middle Name:RENEE'
Other - Last Name:CHADWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NURSE PRACTITIONER
Mailing Address - Street 1:9200 SHELBYVILLE RD STE 531
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-5132
Mailing Address - Country:US
Mailing Address - Phone:502-792-0236
Mailing Address - Fax:
Practice Address - Street 1:3901 CENTRAL PIKE STE 500
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-3431
Practice Address - Country:US
Practice Address - Phone:502-792-0236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN91404163W00000X
TN11952363LF0000X, 363L00000X
KY3005157363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN11952OtherAPN
TN3341073Medicaid
KYP400040902OtherMEDICARE PTAN
KY7100006230Medicaid
Q79557Medicare UPIN