Individual provider Active NPI

Cynthiia Collum, RNFA, BSN

  • Surgical Physician Assistant
  • Texarkana, TX
National Provider Identifier
1164466280
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
234077 Issued in TX
Practice address
5420 Medical Parkway Dr
Texarkana, TX 75503-4622
Phone
(903) 793-8966
Fax
(903) 792-1722
NPI assigned
Jun 16, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 234077 TX Primary

Addresses

Primary practice location

5420 Medical Parkway Dr
Texarkana, TX 75503-4622

Mailing address

5420 Medical Parkway Dr
Texarkana, TX 75503-4622
Phone (903) 793-8966

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Bachelor on Science - Nursing

State licenses

LicenseStateTypeSpecialty
234077TXMDSurgical Physician Assistant

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1164466280",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5420 MEDICAL PARKWAY DR",
            "city": "TEXARKANA",
            "state": "TX",
            "postal_code": "755034622",
            "telephone_number": "903-793-8966",
            "fax_number": "903-792-1722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5420 MEDICAL PARKWAY DR",
            "city": "TEXARKANA",
            "state": "TX",
            "postal_code": "755034622",
            "telephone_number": "903-793-8966",
            "fax_number": "903-792-1722"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COLLUM",
        "first_name": "CYNTHIIA",
        "name_prefix": "Ms.",
        "credential": "RNFA, BSN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-16",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "TX",
            "license": "234077",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Texarkana, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.