Basic Information
| Provider Information | |||||||||
| NPI: | 1013981083 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PACKER | ||||||||
| FirstName: | CINDY | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | CNS | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 4127 | ||||||||
| Address2: | |||||||||
| City: | ROANOKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 240150127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9409819394 | ||||||||
| FaxNumber: | 5403447154 | ||||||||
| Practice Location | |||||||||
| Address1: | 19 BRIAR KNOLL CT | ||||||||
| Address2: | STE 1 | ||||||||
| City: | FISHERSVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 229392635 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5409490955 | ||||||||
| FaxNumber: | 5409498377 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2006 | ||||||||
| LastUpdateDate: | 09/16/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 364S00000X | 0024165889 | VA | N | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | 363LP0808X | 0024165889 | VA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 085354M | 01 | VA | OPTIMA BEHAVORIAL | OTHER | 172650 | 01 | VA | ANTHEM BEHAVORIAL | OTHER | 5596863 | 01 | VA | FIRST HEALTH | OTHER | 010093317 | 01 | VA | VIRGINIA PREMIER | OTHER | 010093317 | 05 | VA | MEDICAID |