Provider Demographics
NPI:1194916163
Name:FUSSELL, CYNTHIA CRAWFORD (APRN)
Entity type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:CRAWFORD
Last Name:FUSSELL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19153 COUNTRY CLUB LN
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70401-3426
Mailing Address - Country:US
Mailing Address - Phone:985-507-2020
Mailing Address - Fax:
Practice Address - Street 1:9938 AIRLINE HWY
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-8100
Practice Address - Country:US
Practice Address - Phone:225-663-2881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAPO3602363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1564028Medicaid