Provider Demographics
NPI:1396824264
Name:WIKOFF, CASSIDY (DNP, ACNP-AG, FNP)
Entity Type:Individual
Prefix:
First Name:CASSIDY
Middle Name:
Last Name:WIKOFF
Suffix:
Gender:F
Credentials:DNP, ACNP-AG, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:434 STONERIDGE RD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:AR
Mailing Address - Zip Code:72007-8052
Mailing Address - Country:US
Mailing Address - Phone:501-744-8262
Mailing Address - Fax:
Practice Address - Street 1:9500 KANIS RD STE 410
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6377
Practice Address - Country:US
Practice Address - Phone:501-202-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2021-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGAA-NP000101363LA2100X
ARA001940363LF0000X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5A302OtherMCRA
ARP00385212OtherMCRA RR