Provider Demographics
NPI:1275106494
Name:NIELSEN, KASSANDRA KAMMA (RNFA, CNOR, BSN)
Entity Type:Individual
Prefix:
First Name:KASSANDRA
Middle Name:KAMMA
Last Name:NIELSEN
Suffix:
Gender:F
Credentials:RNFA, CNOR, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10488 HORTON DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80925-1474
Mailing Address - Country:US
Mailing Address - Phone:713-876-8746
Mailing Address - Fax:
Practice Address - Street 1:454 WOODPECKER FOREST LN
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77384-3757
Practice Address - Country:US
Practice Address - Phone:713-594-0938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-24
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX923407163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First AssistantGroup - Single Specialty