Provider Demographics
NPI:1023068624
Name:STULL, CASSANDRA LYNN (MPAS, PA-C)
Entity type:Individual
Prefix:MRS
First Name:CASSANDRA
Middle Name:LYNN
Last Name:STULL
Suffix:
Gender:F
Credentials:MPAS, PA-C
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Mailing Address - Street 1:MARY S SHOOK STUDENT HEALTH SERVICES
Mailing Address - Street 2:614 HOWARD ST PO OFFICE BOX 32070
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28608-2070
Mailing Address - Country:US
Mailing Address - Phone:828-262-3100
Mailing Address - Fax:828-262-6262
Practice Address - Street 1:MARY S SHOOK STUDENT HEALTH SERVICES
Practice Address - Street 2:614 HOWARD ST PO OFFICE BOX 32070
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28608-2070
Practice Address - Country:US
Practice Address - Phone:828-262-3100
Practice Address - Fax:828-262-6262
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC001000297363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC200205133OtherUNITED HEALTHCARE
NC56142OtherHEALTHCARE SYSTEMS
NC8989937Medicaid
NC0871437OtherCIGNA
NC34D1018993OtherCLIA WAVE
NC89937OtherPROVIDER BCBS
NCD0263OtherMEDCOST PROVIDER
NC89937OtherPROVIDER BCBS
NC8989937Medicaid
NC34D1018993OtherCLIA WAVE