Basic Information
| Provider Information | |||||||||
| NPI: | 1871052472 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARR | ||||||||
| FirstName: | CASSIDY | ||||||||
| MiddleName: | ALANA | ||||||||
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| Credential: | PMHNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 625 COURT STREET | ||||||||
| Address2: | |||||||||
| City: | SIOUX CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 511011919 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7122523871 | ||||||||
| FaxNumber: | 7122523157 | ||||||||
| Practice Location | |||||||||
| Address1: | 625 COURT STREET | ||||||||
| Address2: | |||||||||
| City: | SIOUX CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 511011919 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7122523871 | ||||||||
| FaxNumber: | 7122523157 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2019 | ||||||||
| LastUpdateDate: | 06/01/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 06/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 127714 | IA | N | Nursing Service Providers | Registered Nurse | 363LP0808X | G159688 | IA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health | 364SP0808X | G159688 | IA | Y | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 127714 | 05 | IA | MEDICAID |