MEDICARE: MRS. CYNTHIA DIANN SMALLING FNP-C

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	AP136002	TX
2	363LF0000X	Family Nurse Practitioner	API136002	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AP136002	OTHER	TX	STATE LICENSE

General Provider Information

NPI Number	:	1457912446
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CYNTHIA DIANN SMALLING FNP-C

Provider Business Mailing Address
First Line	:	5930 LBJ FWY STE 380
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75240-6370
Country	:	US
Telephone Number	:	972-532-7314
Fax Number	:	214-351-1122

Provider Business Practice Location Address
First Line	:	5930 LBJ FWY STE 380
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75240-6370
Country	:	US
Telephone Number	:	972-532-7314
Fax Number	:	214-351-1122

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2019
Last Update Date	:	04/29/2022

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