Provider Demographics
NPI:1073908109
Name:FROM, CASSANDRA KATHERINE ANNE (DO)
Entity Type:Individual
Prefix:MISS
First Name:CASSANDRA
Middle Name:KATHERINE ANNE
Last Name:FROM
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4105 NW 61ST TER
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64151-2561
Mailing Address - Country:US
Mailing Address - Phone:816-520-7697
Mailing Address - Fax:
Practice Address - Street 1:1600 E EVERGREEN ST
Practice Address - Street 2:
Practice Address - City:CAMERON
Practice Address - State:MO
Practice Address - Zip Code:64429-2400
Practice Address - Country:US
Practice Address - Phone:816-520-7697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-06
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MO2016033111207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty