Provider Demographics
NPI:1114621026
Name:HOOTEN, KASSANDRA FAYE (CNA, CVI)
Entity Type:Individual
Prefix:
First Name:KASSANDRA
Middle Name:FAYE
Last Name:HOOTEN
Suffix:
Gender:F
Credentials:CNA, CVI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3433 15TH ST S
Mailing Address - Street 2:
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-6928
Mailing Address - Country:US
Mailing Address - Phone:701-429-7593
Mailing Address - Fax:
Practice Address - Street 1:5518 SUNFLOWER LN S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-3962
Practice Address - Country:US
Practice Address - Phone:701-429-7593
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant