Basic Information
| Provider Information | |||||||||
| NPI: | 1710348875 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANDERSON | ||||||||
| FirstName: | CASSIE | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7900 LEES SUMMIT RD | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641391236 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8164043744 | ||||||||
| FaxNumber: | 8162856923 | ||||||||
| Practice Location | |||||||||
| Address1: | 1439 SW MINTER WAY | ||||||||
| Address2: | |||||||||
| City: | GRAIN VALLEY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640299648 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8164046785 | ||||||||
| FaxNumber: | 8164046724 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2016 | ||||||||
| LastUpdateDate: | 11/09/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 2016004507 | MO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.