Provider Demographics
NPI:1508097486
Name:JOHNSON WHITE, CASSANDRA (LMT)
Entity Type:Individual
Prefix:MS
First Name:CASSANDRA
Middle Name:
Last Name:JOHNSON WHITE
Suffix:
Gender:F
Credentials:LMT
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 633972
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75963-3972
Mailing Address - Country:US
Mailing Address - Phone:936-553-4664
Mailing Address - Fax:
Practice Address - Street 1:7014 NORTH ST
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-1144
Practice Address - Country:US
Practice Address - Phone:936-553-4664
Practice Address - Fax:936-462-7435
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-27
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT032466171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor