Cynthia Johanna Bricknell, FNP
Individual provider Active NPI Family Nurse Practitioner · West Lafayette, IN
NPI 1356776306 · NPPES record last updated Dec 12, 2019
Key facts
- NPI
- 1356776306
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 71004585A (IN)
- Practice address
- 166 Sagamore Pkwy W
West Lafayette, IN 47906-1569 - Phone
- (765) 497-2428
- Fax
- (765) 497-4251
- NPI assigned
- Sep 10, 2013
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20131205001500 | IN | Practitioner - Nurse Practitioner | 2668609207 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 71004585A | IN | MD | Family Nurse Practitioner |
Interoperability endpoints
- cynthiabricknell@idx.allscriptsdirect.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 71004585A | IN | Yes |
Addresses
Primary practice location
166 Sagamore Pkwy W
West Lafayette, IN 47906-1569
Mailing address
502 High St
Logansport, IN 46947-2766
Phone (574) 732-2552
Other providers in West Lafayette, IN
- Carlee D Branch
- Luke Braun
- Krystal Brazel
- Necole Brennan
- Rita Allen Brennan
- Leah Brier
- Britt Michael Borden MD
- Valerie J Brock
- Alyssa Broshar
- Brooklynn Brouhard
All providers in West Lafayette, IN · Family Nurse Practitioner in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 12, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.