MEDICARE: CYNTHIA DOUGHTY CNP FAMILY PRACTICE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	RN288485COA1	OH

General Provider Information

NPI Number	:	1215332192
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CYNTHIA DOUGHTY CNP FAMILY PRACTICE

Provider Business Mailing Address
First Line	:	2691 SAWBURY BLVD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43235-4582
Country	:	US
Telephone Number	:	614-553-7601
Fax Number	:	614-553-7604

Provider Business Practice Location Address
First Line	:	2691 SAWBURY BLVD # 2691
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43235-4582
Country	:	US
Telephone Number	:	740-589-7111
Fax Number	:

Authorized Official
Title or Position	:	OWNER/ NURSE PRATITIONER
Name	:	CYNTHIA KATHLEEN DOUGHTY
Credential	:	CNP
Telephone Number	:	740-553-7601

Provider Enumeration Date	:	11/04/2014
Last Update Date	:	01/13/2020

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