Provider Demographics
NPI:1669192837
Name:SCROGGINS, CASSIE LYNN (REGISTERED NURSE)
Entity type:Individual
Prefix:MRS
First Name:CASSIE
Middle Name:LYNN
Last Name:SCROGGINS
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 S COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:STAUNTON
Mailing Address - State:IL
Mailing Address - Zip Code:62088-1867
Mailing Address - Country:US
Mailing Address - Phone:217-602-1867
Mailing Address - Fax:
Practice Address - Street 1:393 E EDWARDSVILLE RD
Practice Address - Street 2:
Practice Address - City:WOOD RIVER
Practice Address - State:IL
Practice Address - Zip Code:62095-1646
Practice Address - Country:US
Practice Address - Phone:618-259-4111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041418678163WI0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WI0600XNursing Service ProvidersRegistered NurseInfection Control