Provider Demographics
NPI:1700898368
Name:WARE, CYNTHIA R (APRN)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:R
Last Name:WARE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1080
Mailing Address - Street 2:
Mailing Address - City:BURKESVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42717-1080
Mailing Address - Country:US
Mailing Address - Phone:270-858-6655
Mailing Address - Fax:270-858-4027
Practice Address - Street 1:2615 FLAHERTY RD
Practice Address - Street 2:
Practice Address - City:EKRON
Practice Address - State:KY
Practice Address - Zip Code:40117-8805
Practice Address - Country:US
Practice Address - Phone:844-435-0900
Practice Address - Fax:270-858-4029
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3002839363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000232256OtherANTHEM
KY1164657OtherPASSPORT
KY15560077OtherCAQH
KY78008125Medicaid
IN200399710Medicaid
KY2439863000OtherPASSPORT ADVANTAGE
KY2439863000OtherPASSPORT ADVANTAGE
KY0097189Medicare PIN