Provider Demographics
NPI:1790011005
Name:GANUS, CASSANDRA LYNN (PA-C)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:LYNN
Last Name:GANUS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 S MAIN ST
Mailing Address - Street 2:STE 100
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-7801
Mailing Address - Country:US
Mailing Address - Phone:501-279-9000
Mailing Address - Fax:501-279-9011
Practice Address - Street 1:205 E RACE AVE
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-4329
Practice Address - Country:US
Practice Address - Phone:501-279-9000
Practice Address - Fax:501-279-9011
Is Sole Proprietor?:No
Enumeration Date:2009-10-20
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARPA378363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical