Provider Demographics
NPI:1295560290
Name:MOCK, CASONDRA K (RN)
Entity type:Individual
Prefix:
First Name:CASONDRA
Middle Name:K
Last Name:MOCK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5210 GRIGGS RD UNIT 14402
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77221-0819
Mailing Address - Country:US
Mailing Address - Phone:832-366-6449
Mailing Address - Fax:
Practice Address - Street 1:5210 GRIGGS RD UNIT 14402
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77221-0819
Practice Address - Country:US
Practice Address - Phone:832-366-6449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX875858163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice