Healthcare Provider Details

I. General information

NPI: 1013103415
Provider Name (Legal Business Name): CYNTHIA DIANNE ARNOLD-SPRUILL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CYNTHIA DIANNE ARNOLD NP

II. Dates (important events)

Enumeration Date: 09/19/2007
Last Update Date: 08/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 S 13TH AVE
LAUREL MS
39440-4345
US

IV. Provider business mailing address

PO BOX 247
LAUREL MS
39441-0247
US

V. Phone/Fax

Practice location:
  • Phone: 601-649-5990
  • Fax: 601-425-7510
Mailing address:
  • Phone: 601-399-6167
  • Fax: 601-399-6281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR623113
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: