Provider Demographics
NPI:1003205139
Name:COMPTON, CASSONDRA NICHOLE (CRNA)
Entity Type:Individual
Prefix:
First Name:CASSONDRA
Middle Name:NICHOLE
Last Name:COMPTON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:CASSONDRA
Other - Middle Name:NICHOLE
Other - Last Name:HORN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:1 MEDICAL PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-7430
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 MEDICAL PARK BLVD
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-7430
Practice Address - Country:US
Practice Address - Phone:423-844-2686
Practice Address - Fax:423-844-2688
Is Sole Proprietor?:No
Enumeration Date:2015-01-13
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024175655367500000X
TN19489367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered