Healthcare Provider Details

I. General information

NPI: 1275132474
Provider Name (Legal Business Name): CYNTHIA DIANE FORTSON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CYNTHIA DIANE NORSWORTHY FNP

II. Dates (important events)

Enumeration Date: 10/20/2020
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 APACHE DR STE B
JONESBORO AR
72401-7447
US

IV. Provider business mailing address

PO BOX 1960
JONESBORO AR
72403-1960
US

V. Phone/Fax

Practice location:
  • Phone: 870-936-8000
  • Fax: 870-934-3656
Mailing address:
  • Phone: 870-936-8000
  • Fax: 870-934-3656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number215954
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number225756
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: