Basic Information
| Provider Information | |||||||||
| NPI: | 1679668487 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALLEN | ||||||||
| FirstName: | CYNTHIA | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1050 RIVER OAKS DR STE 100 | ||||||||
| Address2: | |||||||||
| City: | FLOWOOD | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392329564 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6012004760 | ||||||||
| FaxNumber: | 6012004742 | ||||||||
| Practice Location | |||||||||
| Address1: | 1050 RIVER OAKS DR STE 100 | ||||||||
| Address2: | |||||||||
| City: | FLOWOOD | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392329564 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6012004760 | ||||||||
| FaxNumber: | 6012004742 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2006 | ||||||||
| LastUpdateDate: | 02/26/2019 | ||||||||
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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 | 207Q00000X | 11328 | MS | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00120124 | 05 | MS | MEDICAID |