Provider Demographics
NPI:1578921417
Name:WALCOTT, KASSIA ANN (LM, CPM)
Entity Type:Individual
Prefix:
First Name:KASSIA
Middle Name:ANN
Last Name:WALCOTT
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3625 HUTCH DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-8965
Mailing Address - Country:US
Mailing Address - Phone:509-592-5279
Mailing Address - Fax:
Practice Address - Street 1:3625 HUTCH DR
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-8965
Practice Address - Country:US
Practice Address - Phone:509-592-5279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-07
Last Update Date:2016-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife