Provider Demographics
NPI:1740955814
Name:RIDER, CASSIE RENEE (CNP)
Entity type:Individual
Prefix:MRS
First Name:CASSIE
Middle Name:RENEE
Last Name:RIDER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1429 MAGEE CT
Mailing Address - Street 2:
Mailing Address - City:LITTLE RIVER
Mailing Address - State:SC
Mailing Address - Zip Code:29566-5927
Mailing Address - Country:US
Mailing Address - Phone:715-222-5958
Mailing Address - Fax:
Practice Address - Street 1:1429 MAGEE CT
Practice Address - Street 2:
Practice Address - City:LITTLE RIVER
Practice Address - State:SC
Practice Address - Zip Code:29566-5927
Practice Address - Country:US
Practice Address - Phone:715-222-5958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-11
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8399363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health