Healthcare Provider Details

I. General information

NPI: 1699195743
Provider Name (Legal Business Name): CASSANDRA GAINES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2014
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3111 S 70TH ST
FORT SMITH AR
72903-5017
US

IV. Provider business mailing address

3111 S 70TH ST
FORT SMITH AR
72903-5017
US

V. Phone/Fax

Practice location:
  • Phone: 479-452-6650
  • Fax:
Mailing address:
  • Phone: 479-452-6650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number26288-M
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: