Healthcare Provider Details

I. General information

NPI: 1659611622
Provider Name (Legal Business Name): CYNTHIA SURER MAGGARD ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2013
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56 MARIE LANGDON DR
MANCHESTER KY
40962-6329
US

IV. Provider business mailing address

210 MARIE LANGDON DR
MANCHESTER KY
40962-6388
US

V. Phone/Fax

Practice location:
  • Phone: 606-599-4080
  • Fax: 606-598-0983
Mailing address:
  • Phone: 606-598-5104
  • Fax: 606-598-0983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3007930
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number3007930
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: