Basic Information
Provider Information
NPI: 1750813242
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MALONE
FirstName: CASSANDRA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: FNP-BC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 333 COMMERCE ST STE 700
Address2:  
City: NASHVILLE
State: TN
PostalCode: 372011835
CountryCode: US
TelephoneNumber: 6156272259
FaxNumber:  
Practice Location
Address1: 5201 KINGSTON PIKE
Address2:  
City: KNOXVILLE
State: TN
PostalCode: 379195026
CountryCode: US
TelephoneNumber: 8659786182
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/03/2017
LastUpdateDate: 03/17/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163W00000X178116TNN Nursing Service ProvidersRegistered Nurse 
363LF0000X22933TNY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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