Provider Demographics
NPI:1629441530
Name:KERRIGAN REDWINE, CASSANDRA MARIE
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:MARIE
Last Name:KERRIGAN REDWINE
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 1:1817 W GORE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73501-3614
Mailing Address - Country:US
Mailing Address - Phone:580-357-3857
Mailing Address - Fax:580-357-3867
Practice Address - Street 1:1817 W GORE BLVD
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73501-3614
Practice Address - Country:US
Practice Address - Phone:580-357-3857
Practice Address - Fax:580-357-3867
Is Sole Proprietor?:No
Enumeration Date:2015-11-02
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator