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NPI Code Detail

MEDICARE: CYNTHIA GAIL FREDERICK CRNP

MEDICARE: CYNTHIA GAIL FREDERICK CRNP
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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner5022407NC
2363LF0000XFamily Nurse Practitioner1-080820AL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12009009580OTHERALAMERICAN NURSES CREDENTIALING CENTER

General Provider Information

NPI Number : 1235475039
Entity Type Code : Individual
Provider Name (Legal Business Name) : CYNTHIA GAIL FREDERICK CRNP
Provider Business Mailing Address
First Line : 3801 BARRETT DR
Second Line :
City : RALEIGH
State : NC
Zip : 27609-7224
Country : US
Telephone Number : 919-870-8409
Fax Number : 877-622-8953
Provider Business Practice Location Address
First Line : 3801 BARRETT DR
Second Line :
City : RALEIGH
State : NC
Zip : 27609-7224
Country : US
Telephone Number : 919-870-8409
Fax Number : 877-622-8953
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/25/2012
Last Update Date : 09/11/2025

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