Healthcare Provider Details

I. General information

NPI: 1821553694
Provider Name (Legal Business Name): CYNTHIA ELIZABETH MARTINEZ APRN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CYNTHIA KAMM NP

II. Dates (important events)

Enumeration Date: 02/06/2019
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2520 BERT KOUNS INDUSTRIAL LOOP STE 105
SHREVEPORT LA
71118-3130
US

IV. Provider business mailing address

2520 BERT KOUNS INDUSTRIAL LOOP STE 105
SHREVEPORT LA
71118-3130
US

V. Phone/Fax

Practice location:
  • Phone: 318-212-5520
  • Fax: 318-212-5540
Mailing address:
  • Phone: 318-212-5520
  • Fax: 318-212-5540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number203676
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: