Basic Information
| Provider Information | |||||||||
| NPI: | 1245478072 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HUNTSMAN | ||||||||
| FirstName: | CINDY | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3088 SW 14TH ST | ||||||||
| Address2: | |||||||||
| City: | NEWCASTLE | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730655002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4054143606 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8100 S WALKER AVE | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731399475 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4056026500 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/02/2009 | ||||||||
| LastUpdateDate: | 03/18/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | R0073104 | OK | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 200233180A | 05 | OK | MEDICAID |