Provider Demographics
NPI:1174927628
Name:PHELAN, CINDY A (LMT)
Entity type:Individual
Prefix:MRS
First Name:CINDY
Middle Name:A
Last Name:PHELAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MRS
Other - First Name:CYNTHIA
Other - Middle Name:A
Other - Last Name:PHELAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMT
Mailing Address - Street 1:3900 GASCONY WAY
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-6342
Mailing Address - Country:US
Mailing Address - Phone:479-883-8851
Mailing Address - Fax:
Practice Address - Street 1:8434 PHOENIX AVE
Practice Address - Street 2:SUITEG
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-6143
Practice Address - Country:US
Practice Address - Phone:479-883-8851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-13
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2824171W00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No171W00000XOther Service ProvidersContractor