MEDICARE: MS. CYNTHIA SUSAN AHEARN FAMILY NURSE PRACTIT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	AP231849	LA
2	363L00000X	Nurse Practitioner	251413	TX

General Provider Information

NPI Number	:	1619919842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CYNTHIA SUSAN AHEARN FAMILY NURSE PRACTIT

Provider Business Mailing Address
First Line	:	PO BOX 914
Second Line	:
City	:	LEHI
State	:	UT
Zip	:	84043-1189
Country	:	US
Telephone Number	:	800-640-3451
Fax Number	:

Provider Business Practice Location Address
First Line	:	2011 N COLLINS BLVD STE 607
Second Line	:
City	:	RICHARDSON
State	:	TX
Zip	:	75080-2636
Country	:	US
Telephone Number	:	800-640-3451
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	03/26/2024

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