Provider Demographics
NPI:1740269802
Name:FRIESON, CASSANDRA W (DNP, CRNP)
Entity type:Individual
Prefix:DR
First Name:CASSANDRA
Middle Name:W
Last Name:FRIESON
Suffix:
Gender:F
Credentials:DNP, CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1547 DELTON PL
Mailing Address - Street 2:
Mailing Address - City:MIDFIELD
Mailing Address - State:AL
Mailing Address - Zip Code:35228-3262
Mailing Address - Country:US
Mailing Address - Phone:205-518-6421
Mailing Address - Fax:844-520-5607
Practice Address - Street 1:401 ARNOLD ST NE
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35055-1967
Practice Address - Country:US
Practice Address - Phone:256-739-9593
Practice Address - Fax:256-739-2984
Is Sole Proprietor?:No
Enumeration Date:2006-01-16
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-056275363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51031454OtherBC/BS OF ALABAMA
AL000031454Medicaid
AL51031454OtherBC/BS OF ALABAMA
AL000031454FRIMedicare ID - Type Unspecified