Healthcare Provider Details

I. General information

NPI: 1942472642
Provider Name (Legal Business Name): CINDY KAY GILL RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2008
Last Update Date: 04/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2732 HUNTSVILLE HWY
FAYETTEVILLE TN
37334-6774
US

IV. Provider business mailing address

2732 HUNTSVILLE HWY
FAYETTEVILLE TN
37334-6774
US

V. Phone/Fax

Practice location:
  • Phone: 931-703-4371
  • Fax:
Mailing address:
  • Phone: 931-703-4371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number198-14688
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: