Healthcare Provider Details

I. General information

NPI: 1922129345
Provider Name (Legal Business Name): CYNTHIA LANELLE HUDGINS-SPARKS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2203 CAMPGROUND RAD
CABOT AR
72023-8234
US

IV. Provider business mailing address

2203 CAMPGROUND RD
CABOT AR
72023-8234
US

V. Phone/Fax

Practice location:
  • Phone: 501-772-4087
  • Fax: 507-257-6976
Mailing address:
  • Phone: 501-772-4087
  • Fax: 507-257-6976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License Number204939
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: