Provider Demographics
NPI:1457180127
Name:AURELIO, CASSIDY JOAN (FNP-C)
Entity type:Individual
Prefix:
First Name:CASSIDY
Middle Name:JOAN
Last Name:AURELIO
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:CASSIDY
Other - Middle Name:JOAN
Other - Last Name:ALBERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 959203
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63195-2108
Mailing Address - Country:US
Mailing Address - Phone:314-953-8788
Mailing Address - Fax:314-953-8798
Practice Address - Street 1:11133 DUNN RD STE 309E
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136-6163
Practice Address - Country:US
Practice Address - Phone:314-273-2234
Practice Address - Fax:314-953-8798
Is Sole Proprietor?:No
Enumeration Date:2024-07-30
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20200009286363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner