Provider Demographics
NPI:1922889229
Name:EXON, KASSIE (BS, EEG)
Entity Type:Individual
Prefix:
First Name:KASSIE
Middle Name:
Last Name:EXON
Suffix:
Gender:F
Credentials:BS, EEG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 BOLAND ST STE 211
Mailing Address - Street 2:
Mailing Address - City:FT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-1265
Mailing Address - Country:US
Mailing Address - Phone:903-259-0550
Mailing Address - Fax:
Practice Address - Street 1:111 BOLAND ST STE 211
Practice Address - Street 2:
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-1265
Practice Address - Country:US
Practice Address - Phone:903-259-0550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-12
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0500XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherEEG