Provider Demographics
NPI:1821688334
Name:STRONG, KASANDRA NICOLE ANTIONETTE (NP)
Entity Type:Individual
Prefix:MRS
First Name:KASANDRA
Middle Name:NICOLE ANTIONETTE
Last Name:STRONG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:KASANDRA
Other - Middle Name:NICOLE ANTIONETTE
Other - Last Name:PHANARA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11750 W 2ND PL STE 365
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-1731
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11750 W 2ND PL
Practice Address - Street 2:STE 365
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-1731
Practice Address - Country:US
Practice Address - Phone:720-321-8280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-20
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0996321-NP363LF0000X
CO000000000363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily