Provider Demographics
NPI:1679179311
Name:BURCHETT, CASSANDRA BROOKE (RN)
Entity Type:Individual
Prefix:MS
First Name:CASSANDRA
Middle Name:BROOKE
Last Name:BURCHETT
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:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:WV
Mailing Address - Zip Code:26537-0010
Mailing Address - Country:US
Mailing Address - Phone:304-329-0464
Mailing Address - Fax:304-329-2584
Practice Address - Street 1:108 SENIOR CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:WV
Practice Address - Zip Code:26537-2653
Practice Address - Country:US
Practice Address - Phone:304-329-0464
Practice Address - Fax:304-329-2584
Is Sole Proprietor?:No
Enumeration Date:2020-12-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1155403163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1155403OtherKENTUCKY BOARD OF NURSING