Healthcare Provider Details

I. General information

NPI: 1982183760
Provider Name (Legal Business Name): NICOLE ANNE CASSEDY FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICOLE ANNE GOULD

II. Dates (important events)

Enumeration Date: 08/13/2018
Last Update Date: 03/03/2020
Certification Date: 03/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3184 CHURN CREEK RD
REDDING CA
96002-2122
US

IV. Provider business mailing address

1441 LIBERTY ST
REDDING CA
96001-0811
US

V. Phone/Fax

Practice location:
  • Phone: 530-768-2436
  • Fax:
Mailing address:
  • Phone: 530-224-2700
  • Fax: 530-224-2738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95009661
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: