Provider Demographics
NPI:1528485836
Name:MCDOUGAL, CYNTHIA (APRN)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:MCDOUGAL
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 1:129 DONNA ST
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-3462
Mailing Address - Country:US
Mailing Address - Phone:601-566-1734
Mailing Address - Fax:
Practice Address - Street 1:129 DONNA ST
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-3462
Practice Address - Country:US
Practice Address - Phone:601-566-1734
Practice Address - Fax:601-566-1734
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-25
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR850505363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily