Provider Demographics
NPI:1093155673
Name:DOUGHTY, CYNTHIA KATHLEEN (APRN-CNP)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:KATHLEEN
Last Name:DOUGHTY
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:K
Other - Last Name:HICKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-293-8617
Mailing Address - Fax:614-685-5246
Practice Address - Street 1:1025 REFUGEE RD FL 2
Practice Address - Street 2:
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-9861
Practice Address - Country:US
Practice Address - Phone:614-293-8617
Practice Address - Fax:614-685-5246
Is Sole Proprietor?:No
Enumeration Date:2013-06-27
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.288485-COA 1363LP2300X
OHAPRN.CNP.14572363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0086421Medicaid