Provider Demographics
NPI:1063817476
Name:CASSIDY, BRYANT PATRICE (LM CPM)
Entity Type:Individual
Prefix:
First Name:BRYANT
Middle Name:PATRICE
Last Name:CASSIDY
Suffix:
Gender:F
Credentials:LM CPM
Other - Prefix:
Other - First Name:BRYANT
Other - Middle Name:PATRICE
Other - Last Name:SARENSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPM
Mailing Address - Street 1:2003 SOUTHWOOD HILLS DR
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:TX
Mailing Address - Zip Code:76574-4873
Mailing Address - Country:US
Mailing Address - Phone:913-283-5768
Mailing Address - Fax:
Practice Address - Street 1:2003 SOUTHWOOD HILLS DR
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:TX
Practice Address - Zip Code:76574-4873
Practice Address - Country:US
Practice Address - Phone:913-283-5768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-28
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX99473176B00000X
176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife