Provider Demographics
NPI:1629211123
Name:BEYER, KASSANDRA (RN)
Entity Type:Individual
Prefix:
First Name:KASSANDRA
Middle Name:
Last Name:BEYER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6920 SUGAR MAPLE CRK
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75023-2061
Mailing Address - Country:US
Mailing Address - Phone:214-497-9268
Mailing Address - Fax:972-398-3664
Practice Address - Street 1:6920 SUGAR MAPLE CRK
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75023-2061
Practice Address - Country:US
Practice Address - Phone:214-497-9268
Practice Address - Fax:972-398-3664
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-13
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX760615171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator