Provider Demographics
NPI:1528208824
Name:STOREY, CASSANDRA D (PA-C)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:D
Last Name:STOREY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 DOCTORS DR
Mailing Address - Street 2:
Mailing Address - City:EMPORIA
Mailing Address - State:VA
Mailing Address - Zip Code:23847-1240
Mailing Address - Country:US
Mailing Address - Phone:434-634-6101
Mailing Address - Fax:
Practice Address - Street 1:6 DOCTORS DR
Practice Address - Street 2:
Practice Address - City:EMPORIA
Practice Address - State:VA
Practice Address - Zip Code:23847-1240
Practice Address - Country:US
Practice Address - Phone:434-634-6101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-26
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC001001636363A00000X
VA0110004112363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant