Provider Demographics
NPI:1629177738
Name:CASSITY, ABBE MARISSA (DO)
Entity Type:Individual
Prefix:DR
First Name:ABBE
Middle Name:MARISSA
Last Name:CASSITY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1101 SAINT CHRISTOPHER DR STE 250
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-7088
Mailing Address - Country:US
Mailing Address - Phone:606-836-3193
Mailing Address - Fax:606-836-2564
Practice Address - Street 1:1101 SAINT CHRISTOPHER DR STE 250
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7088
Practice Address - Country:US
Practice Address - Phone:606-836-3196
Practice Address - Fax:606-836-2564
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY02973207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100004750Medicaid
OH2697327Medicaid
KYP400034703Medicare PIN
OH2697327Medicaid