Provider Demographics
NPI:1245005768
Name:CURRY, CASSANDRA J
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:J
Last Name:CURRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 GRANDVIEW ST
Mailing Address - Street 2:
Mailing Address - City:GAUTIER
Mailing Address - State:MS
Mailing Address - Zip Code:39553-2315
Mailing Address - Country:US
Mailing Address - Phone:228-217-3546
Mailing Address - Fax:
Practice Address - Street 1:1209 GRANDVIEW ST
Practice Address - Street 2:
Practice Address - City:GAUTIER
Practice Address - State:MS
Practice Address - Zip Code:39553-2315
Practice Address - Country:US
Practice Address - Phone:228-217-3546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-15
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS800839626172A00000X, 342000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes342000000XTransportation ServicesTransportation Network Company
No172A00000XOther Service ProvidersDriverGroup - Multi-Specialty