Provider Demographics
NPI:1003659079
Name:MCKILLIP, CASSIE J (FNP-C)
Entity type:Individual
Prefix:
First Name:CASSIE
Middle Name:J
Last Name:MCKILLIP
Suffix:
Gender:
Credentials:FNP-C
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6983 HILLSDALE CT
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2054
Mailing Address - Country:US
Mailing Address - Phone:317-849-8350
Mailing Address - Fax:317-849-8358
Practice Address - Street 1:2330 S DIXON RD STE 325
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-6430
Practice Address - Country:US
Practice Address - Phone:765-455-8822
Practice Address - Fax:765-865-3935
Is Sole Proprietor?:No
Enumeration Date:2024-06-17
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN28233872A163W00000X
IN71015652A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300096968Medicaid