Individual
CYNTHIA L DANIEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1203 AMERICAN GREETING CARD RD, CORBIN, KY 40701-4811
(606) 528-7010
Mailing address
PO BOX 568, CORBIN, KY 40702-0568
(606) 528-7010
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
007441
NY
363A00000X
Physician Assistant
1596
MA
363A00000X
Physician Assistant
Primary
PA2110
KY
363A00000X
Physician Assistant
TC487
KY
363AM0700X
Medical Physician Assistant
1803
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1520901
TENNESSEE MEDICAID/TENNCARE PROGRAM
TN
05
—
1520901
—
TN
05
—
7100429590
—
KY
Enumeration date
05/22/2006
Last updated
12/13/2016
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