Provider Demographics
NPI:1598517443
Name:WATTS, CASSANDRA KAY (FNP-C)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:KAY
Last Name:WATTS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8128 NE 99TH TER
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64157-7841
Mailing Address - Country:US
Mailing Address - Phone:816-820-9811
Mailing Address - Fax:
Practice Address - Street 1:8128 NE 99TH TER
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64157-7841
Practice Address - Country:US
Practice Address - Phone:816-820-9811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012020431163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice