Provider Demographics
NPI:1356481782
Name:CASSEDY, GRETCHEN (APRN)
Entity Type:Individual
Prefix:MS
First Name:GRETCHEN
Middle Name:
Last Name:CASSEDY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 391
Mailing Address - Street 2:
Mailing Address - City:ESTHERWOOD
Mailing Address - State:LA
Mailing Address - Zip Code:70534-0391
Mailing Address - Country:US
Mailing Address - Phone:337-384-1334
Mailing Address - Fax:
Practice Address - Street 1:3108 AIRPORT ROAD
Practice Address - Street 2:
Practice Address - City:ESTHERWOOD
Practice Address - State:LA
Practice Address - Zip Code:70534
Practice Address - Country:US
Practice Address - Phone:337-384-1334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP03174363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner