Healthcare Provider Details

I. General information

NPI: 1932191335
Provider Name (Legal Business Name): CYNTHIA JO EMMICK ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 01/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8070 U.S. HWY. 60 WEST
LEWISPORT KY
42351-0078
US

IV. Provider business mailing address

8070 U.S. HWY. 60 WEST
LEWISPORT KY
42351-0078
US

V. Phone/Fax

Practice location:
  • Phone: 270-295-3400
  • Fax: 270-295-3401
Mailing address:
  • Phone: 270-295-3400
  • Fax: 270-295-3401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3002821
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: