Provider Demographics
NPI:1831466077
Name:KING, CASSANDRA L (ARNP)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:L
Last Name:KING
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1236 E RUSHOLME ST STE 300
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52803-2473
Mailing Address - Country:US
Mailing Address - Phone:563-324-2992
Mailing Address - Fax:563-324-8562
Practice Address - Street 1:1100 36TH AVENUE
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265
Practice Address - Country:US
Practice Address - Phone:309-743-6700
Practice Address - Fax:309-764-2042
Is Sole Proprietor?:No
Enumeration Date:2011-11-16
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209009207363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health