Provider Demographics
NPI:1285144865
Name:KING, CYNTHIA ANN
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:ANN
Last Name:KING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 192
Mailing Address - Street 2:
Mailing Address - City:WADESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28170-0192
Mailing Address - Country:US
Mailing Address - Phone:704-694-6700
Mailing Address - Fax:704-694-5454
Practice Address - Street 1:1315 E SUNSET DR STE 101
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-4333
Practice Address - Country:US
Practice Address - Phone:704-694-6700
Practice Address - Fax:704-694-5454
Is Sole Proprietor?:No
Enumeration Date:2017-10-09
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCF09170738363LF0000X
NC5009914363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily