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General NPI Number Information
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NPI Number | 1508254954
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Entity Type | Organization
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Legal Business Name | CINDY A MAYBERRY APN LLC
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Dates
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Enumeration Date | 01/07/2015
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Last Update Date | 01/07/2015
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Provider Practice Location Address
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Address Line | 705 E LAHARPE ST STE D
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City | KIRKSVILLE
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State | MO
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Zip | 63501-4526
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Country | US
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Telephone | 660-665-3545
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Fax | 660-665-3226
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Provider Business Mailing Address
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Address Line | 705 E LAHARPE ST STE D
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City | KIRKSVILLE
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State | MO
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Zip | 63501-4526
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | CINDY MAYBERRY
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Credential |
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Telephone | 660-665-3545
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364SP0808X
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Taxonomy Name | Psychiatric/Mental Health Clinical Nurse Specialist
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License Number | 100516
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License Number State | MO
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