Provider Demographics
NPI:1710348875
Name:ANDERSON, CASSIE R (NP)
Entity Type:Individual
Prefix:
First Name:CASSIE
Middle Name:R
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7900 LEES SUMMIT RD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64139-1236
Mailing Address - Country:US
Mailing Address - Phone:816-404-3744
Mailing Address - Fax:816-285-6923
Practice Address - Street 1:1439 SW MINTER WAY
Practice Address - Street 2:
Practice Address - City:GRAIN VALLEY
Practice Address - State:MO
Practice Address - Zip Code:64029-9648
Practice Address - Country:US
Practice Address - Phone:816-404-6785
Practice Address - Fax:816-404-6724
Is Sole Proprietor?:No
Enumeration Date:2016-03-16
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016004507363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily