Provider Demographics
NPI:1881789972
Name:SHIPMAN-WADLEY, CASSANDRA J (BC-FNP)
Entity type:Individual
Prefix:MRS
First Name:CASSANDRA
Middle Name:J
Last Name:SHIPMAN-WADLEY
Suffix:
Gender:F
Credentials:BC-FNP
Other - Prefix:MRS
Other - First Name:CASSANDRA
Other - Middle Name:J
Other - Last Name:SHIPMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BC-FNP
Mailing Address - Street 1:2635 SUMMER RAIN DR
Mailing Address - Street 2:
Mailing Address - City:MANVEL
Mailing Address - State:TX
Mailing Address - Zip Code:77578-3117
Mailing Address - Country:US
Mailing Address - Phone:713-516-7005
Mailing Address - Fax:
Practice Address - Street 1:3550 SWINGLE RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77047-3763
Practice Address - Country:US
Practice Address - Phone:713-547-1000
Practice Address - Fax:713-547-1166
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX711193363LF0000X
MI4704209034363LF0000X
TXAP114448363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L16748Medicare PIN
TX1053352914Medicare NSC