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General NPI Number Information
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NPI Number | 1619919842
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Entity Type | Individual
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Provider Name | CYNTHIA SUSAN AHEARN FAMILY NURSE PRACTIT
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Gender | Female
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Dates
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Enumeration Date | 06/12/2006
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Last Update Date | 03/26/2024
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Provider Practice Location Address
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Address Line | 2011 N COLLINS BLVD STE 607
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City | RICHARDSON
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State | TX
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Zip | 75080-2636
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Country | US
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Telephone | 800-640-3451
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 914
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City | LEHI
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State | UT
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Zip | 84043-1189
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Country | US
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Telephone | 800-640-3451
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | AP231849
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 251413
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License Number State | TX
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