Provider Demographics
NPI:1396706180
Name:NELSON, CYNTHIA T (APN)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:T
Last Name:NELSON
Suffix:
Gender:F
Credentials:APN
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 21850
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71903-1850
Mailing Address - Country:US
Mailing Address - Phone:501-622-3979
Mailing Address - Fax:501-622-3993
Practice Address - Street 1:ONE MERCY LANE,
Practice Address - Street 2:SUITE 405
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-6441
Practice Address - Country:US
Practice Address - Phone:501-622-3979
Practice Address - Fax:501-622-3993
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA01310 ANP363L00000X
ARA01310363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR136146758Medicaid
AR5V243Medicare PIN
AR136146758Medicaid
S64011Medicare UPIN