Provider Demographics
NPI:1720603459
Name:VIETS, CASSANDRE D (NP-C)
Entity Type:Individual
Prefix:
First Name:CASSANDRE
Middle Name:D
Last Name:VIETS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2271 E 330TH RD
Mailing Address - Street 2:
Mailing Address - City:GOODSON
Mailing Address - State:MO
Mailing Address - Zip Code:65663-7124
Mailing Address - Country:US
Mailing Address - Phone:417-840-6246
Mailing Address - Fax:
Practice Address - Street 1:1155 W PARKVIEW ST STE 1C
Practice Address - Street 2:
Practice Address - City:BOLIVAR
Practice Address - State:MO
Practice Address - Zip Code:65613-7800
Practice Address - Country:US
Practice Address - Phone:417-326-7246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-09
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011015999163W00000X
MO2020016219363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse