Provider Demographics
NPI:1760639256
Name:FELTS, CASSY C (MD)
Entity Type:Individual
Prefix:DR
First Name:CASSY
Middle Name:C
Last Name:FELTS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CASSY
Other - Middle Name:L
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:816 W CANNON ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-3146
Mailing Address - Country:US
Mailing Address - Phone:817-321-0404
Mailing Address - Fax:
Practice Address - Street 1:4005 24TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1815
Practice Address - Country:US
Practice Address - Phone:806-792-2767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-26
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN98342085R0202X, 2085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX300782501Medicaid
NM74100742OtherNM MEDICAID
TX8DD226OtherBCBS
NM74100742OtherNM MEDICAID