Provider Demographics
NPI:1992787907
Name:LUTHER, CYNTHIA H (AGPCNP, FNP)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:H
Last Name:LUTHER
Suffix:
Gender:F
Credentials:AGPCNP, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 12TH ST
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301-4158
Mailing Address - Country:US
Mailing Address - Phone:601-703-9956
Mailing Address - Fax:601-703-6795
Practice Address - Street 1:1800 12TH ST
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-4158
Practice Address - Country:US
Practice Address - Phone:601-703-9956
Practice Address - Fax:601-703-6795
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR543837363LF0000X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
500004197OtherRAILROAD MEDICARE
MS00115861Medicaid
500000363Medicare ID - Type Unspecified
500004197OtherRAILROAD MEDICARE