Healthcare Provider Details

I. General information

NPI: 1427966654
Provider Name (Legal Business Name): KASSANDRA JEAN MARIE CAUCKWELL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2026
Last Update Date: 08/29/2026
Certification Date: 08/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2976 KROY WAY
SACRAMENTO CA
95817-2635
US

IV. Provider business mailing address

2976 KROY WAY
SACRAMENTO CA
95817-2635
US

V. Phone/Fax

Practice location:
  • Phone: 707-813-1415
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95040935
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: