Healthcare Provider Details

I. General information

NPI: 1396706180
Provider Name (Legal Business Name): CYNTHIA T NELSON APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 06/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE MERCY LANE, SUITE 405
HOT SPRINGS AR
71913-6441
US

IV. Provider business mailing address

PO BOX 21850
HOT SPRINGS AR
71903-1850
US

V. Phone/Fax

Practice location:
  • Phone: 501-622-3979
  • Fax: 501-622-3993
Mailing address:
  • Phone: 501-622-3979
  • Fax: 501-622-3993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberA01310 ANP
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberA01310
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: