Healthcare Provider Details

I. General information

NPI: 1104762608
Provider Name (Legal Business Name): AUSTIN CODY CUNNINGHAM FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 07/04/2026
Certification Date: 07/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 FARM ROAD 195
PARIS TX
75462-2806
US

IV. Provider business mailing address

885 BEAVER CREEK RD
POWDERLY TX
75473-5661
US

V. Phone/Fax

Practice location:
  • Phone: 903-739-7920
  • Fax:
Mailing address:
  • Phone: 903-227-6484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1242022
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number805022
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: