Basic Information
| Provider Information | |||||||||
| NPI: | 1164527032 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NORTHCUTT | ||||||||
| FirstName: | CYNTHIA | ||||||||
| MiddleName: | L. | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 320 WHITTINGTON PKWY | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402224928 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5026255584 | ||||||||
| FaxNumber: | 5024262264 | ||||||||
| Practice Location | |||||||||
| Address1: | 320 WHITTINGTON PKWY | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402224928 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5026255584 | ||||||||
| FaxNumber: | 5024262264 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2006 | ||||||||
| LastUpdateDate: | 03/22/2016 | ||||||||
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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 | 163W00000X | 1095803 | KY | N | Nursing Service Providers | Registered Nurse | 367500000X | 3005041 | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.