Provider Demographics
NPI:1275397713
Name:CASSITY, OLIVIA MARIE (FNP-C)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:MARIE
Last Name:CASSITY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:OLIVIA
Other - Middle Name:MARIE
Other - Last Name:HAMMOURI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10577 S REDWOOD RD STE 109
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-8504
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10577 S REDWOOD RD STE 109
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-8504
Practice Address - Country:US
Practice Address - Phone:801-559-7455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9799959-4405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner