Basic Information
| Provider Information | |||||||||
| NPI: | 1528215407 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HONEYCUTT | ||||||||
| FirstName: | CYNTHIA | ||||||||
| MiddleName: | KUPSICK | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | ANP-BC | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | NORTON | ||||||||
| OtherFirstName: | CYNTHIA | ||||||||
| OtherMiddleName: | KUPSICK | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | ANP-BC | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1420G US HIGHWAY 52 N | ||||||||
| Address2: | |||||||||
| City: | ALBEMARLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280012622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7049820161 | ||||||||
| FaxNumber: | 7045124838 | ||||||||
| Practice Location | |||||||||
| Address1: | 105 YADKIN ST | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | ALBEMARLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280013449 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7049820161 | ||||||||
| FaxNumber: | 7045124808 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2008 | ||||||||
| LastUpdateDate: | 08/24/2016 | ||||||||
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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 | 364SA2200X | 5004069 | NC | N | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Adult Health | 363L00000X | 152864 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | NC8170C | 01 | NC | MEDICARE INDIVIDUAL PROVIDER NUMBER | OTHER | 7005393 | 05 | NC | MEDICAID | NP3299 | 05 | SC | MEDICAID | 1528215407 | 05 | NC | MEDICAID |