Provider Demographics
NPI:1235475039
Name:FREDERICK, CYNTHIA GAIL (CRNP)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:GAIL
Last Name:FREDERICK
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MS
Other - First Name:CYNTHIA
Other - Middle Name:GAIL
Other - Last Name:DONALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:3801 BARRETT DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-7224
Mailing Address - Country:US
Mailing Address - Phone:919-870-8409
Mailing Address - Fax:877-622-8953
Practice Address - Street 1:3801 BARRETT DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7224
Practice Address - Country:US
Practice Address - Phone:919-870-8409
Practice Address - Fax:877-622-8953
Is Sole Proprietor?:No
Enumeration Date:2012-12-25
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5022407363LP0808X
AL1-080820363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL2009009580OtherAMERICAN NURSES CREDENTIALING CENTER