Provider Demographics
NPI:1114451754
Name:CYNOWA, HEATHER LYNN (PMHNP-BC, FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:LYNN
Last Name:CYNOWA
Suffix:
Gender:F
Credentials:PMHNP-BC, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1023 FAIRFIELD CIR
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-6607
Mailing Address - Country:US
Mailing Address - Phone:910-550-3803
Mailing Address - Fax:910-550-3803
Practice Address - Street 1:304 BARCELONA DR APT 13A
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-5752
Practice Address - Country:US
Practice Address - Phone:984-304-8330
Practice Address - Fax:984-305-8331
Is Sole Proprietor?:No
Enumeration Date:2017-04-19
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5009667363L00000X
NC2024027949363LP0808X
NC2017002067363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily