Provider Demographics
NPI:1699718601
Name:HANEY, CYNTHIA J (PA)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:J
Last Name:HANEY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1932 ALCOA HWY
Mailing Address - Street 2:SUITE 255
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-1527
Mailing Address - Country:US
Mailing Address - Phone:865-524-1869
Mailing Address - Fax:865-544-6533
Practice Address - Street 1:1932 ALCOA HWY
Practice Address - Street 2:SUITE 255
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-1527
Practice Address - Country:US
Practice Address - Phone:865-524-1869
Practice Address - Fax:865-544-6533
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03140363AS0400X
TNPA1528363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1505488Medicaid
TNCC0589OtherMEDICARE RAILROAD
TX8N3690OtherBCBS
TXP00077348OtherRAILROAD MEDICARE
TN36651972Medicare PIN
TX8N3690OtherBCBS
TX8A2700Medicare ID - Type Unspecified
TNCC0589OtherMEDICARE RAILROAD