Provider Demographics
NPI:1750154100
Name:SWAYNE, CASSIE (CNM)
Entity type:Individual
Prefix:
First Name:CASSIE
Middle Name:
Last Name:SWAYNE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:CASSIE
Other - Middle Name:
Other - Last Name:TEDROW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37662-0009
Mailing Address - Country:US
Mailing Address - Phone:423-857-2066
Mailing Address - Fax:
Practice Address - Street 1:320 BRISTOL WEST BLVD STE 2C
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-8773
Practice Address - Country:US
Practice Address - Phone:423-844-1399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN35011367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife