Healthcare Provider Details

I. General information

NPI: 1295670743
Provider Name (Legal Business Name): CASSANDRA ANN KERNICK
Entity Type: Individual
Gender:
Sole Proprietor: Y

Provider Other Name: CASS KERNICK

II. Dates (important events)

Enumeration Date: 04/21/2026
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1029 E 8TH AVE APT 908
DENVER CO
80218-3347
US

IV. Provider business mailing address

1029 E 8TH AVE APT 908
DENVER CO
80218-3347
US

V. Phone/Fax

Practice location:
  • Phone: 308-293-5893
  • Fax:
Mailing address:
  • Phone: 308-293-5893
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: