Healthcare Provider Details

I. General information

NPI: 1548171606
Provider Name (Legal Business Name): CYNTHIA KELE MCCORD MLS(ASCP)CM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CYNTIHA NAKATA MLS(ASCP)CM

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 N COLLEGE AVE
FAYETTEVILLE AR
72703-1944
US

IV. Provider business mailing address

4019 W LOOKOUT CIR
FAYETTEVILLE AR
72704-5433
US

V. Phone/Fax

Practice location:
  • Phone: 479-443-4301
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number25446407
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: