Provider Demographics
NPI:1669207536
Name:STEWARD, CASSIDY ANNE (FNP)
Entity type:Individual
Prefix:
First Name:CASSIDY
Middle Name:ANNE
Last Name:STEWARD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:529 E CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-3310
Mailing Address - Country:US
Mailing Address - Phone:307-250-3266
Mailing Address - Fax:
Practice Address - Street 1:424 YELLOWSTONE AVE STE 220
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-9310
Practice Address - Country:US
Practice Address - Phone:307-578-2486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-03
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY41439163WE0003X
WY55490363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WE0003XNursing Service ProvidersRegistered NurseEmergency