Healthcare Provider Details

I. General information

NPI: 1376557017
Provider Name (Legal Business Name): CYNTHIA ANN SMITH C-FNP, DNP, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 03/08/2024
Certification Date: 03/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 SPRING VALLEY DR
HUNTINGTON WV
25704-9501
US

IV. Provider business mailing address

1540 SPRING VALLEY DR
HUNTINGTON WV
25704-9501
US

V. Phone/Fax

Practice location:
  • Phone: 304-429-6741
  • Fax:
Mailing address:
  • Phone: 304-429-6741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number56329
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPRN56329
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: