Provider Demographics
NPI:1972973113
Name:JOHNS, CASSIDY RAE CHATHAM (NP)
Entity Type:Individual
Prefix:MRS
First Name:CASSIDY
Middle Name:RAE CHATHAM
Last Name:JOHNS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:CASSIDY
Other - Middle Name:
Other - Last Name:CHATHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2217 MISTLE THRUSH DR
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89084-2223
Mailing Address - Country:US
Mailing Address - Phone:580-220-8686
Mailing Address - Fax:
Practice Address - Street 1:6900 N DURANGO DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-4409
Practice Address - Country:US
Practice Address - Phone:702-835-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-30
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZTAP8189363LA2100X
AZTAP8190363LF0000X
NVAPRN002586363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily