# CYNTHIA KAY KIESEL

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1558405753
- **Gender:** F
- **Credential:** FNP-BC

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | 71002188A | IN | Yes |
| 363LF0000X | Family Nurse Practitioner | 71002188A | IN | — |
| 363LP2300X | Primary Care Nurse Practitioner | 71002188A | IN | — |

## Other

- **Enumeration date:** 02/19/2007
- **Last updated:** 11/26/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000000545658 | ANTHEM PIN | IN |
| 01 | — | 200859330E | MEDICAID GROUP | IN |
| 05 | — | 200885350 | — | IN |
| 01 | — | 250470 | MEDICARE GROUP | IN |