Provider Demographics
NPI:1770168239
Name:EDWARDS, CASSIDY (PA-C)
Entity type:Individual
Prefix:
First Name:CASSIDY
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CASSIDY
Other - Middle Name:
Other - Last Name:MULL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:259 N BOATMAN RD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47170-7941
Mailing Address - Country:US
Mailing Address - Phone:812-595-7723
Mailing Address - Fax:
Practice Address - Street 1:443 SPRING ST STE 200
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-4494
Practice Address - Country:US
Practice Address - Phone:812-288-8360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-16
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10003976B363AM0700X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical