Provider Demographics
NPI:1659929743
Name:COFFEY, CASSIDY RENEE
Entity Type:Individual
Prefix:
First Name:CASSIDY
Middle Name:RENEE
Last Name:COFFEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 ESTELLE AVE
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76541-7382
Mailing Address - Country:US
Mailing Address - Phone:254-466-0541
Mailing Address - Fax:
Practice Address - Street 1:910 ESTELLE AVE
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76541-7382
Practice Address - Country:US
Practice Address - Phone:254-466-0541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-31
Last Update Date:2019-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider