Healthcare Provider Details

I. General information

NPI: 1164546727
Provider Name (Legal Business Name): CYNTHIA LOUISE OPTHOLT CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 01/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 GORDON SMITH DRIVE
MOBILE AL
36617
US

IV. Provider business mailing address

5750-A SOUTHLAND DRIVE
MOBILE AL
36693
US

V. Phone/Fax

Practice location:
  • Phone: 251-473-4423
  • Fax:
Mailing address:
  • Phone: 251-450-5901
  • Fax: 251-662-7297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP9191309
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1037156
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1037156
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: