Healthcare Provider Details

I. General information

NPI: 1063046811
Provider Name (Legal Business Name): CASSANDRA A BOEHNING FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CASSANDRA DAVIS

II. Dates (important events)

Enumeration Date: 03/02/2020
Last Update Date: 11/29/2024
Certification Date: 11/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4745 OGLETOWN STANTON RD STE 105
NEWARK DE
19713-2070
US

IV. Provider business mailing address

2790 CLAY EDWARDS DR STE 530
NORTH KANSAS CITY MO
64116-3266
US

V. Phone/Fax

Practice location:
  • Phone: 302-368-3257
  • Fax: 302-368-3237
Mailing address:
  • Phone: 816-452-3300
  • Fax: 816-453-0677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberL1-0055770
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberLG-0001394
License Number StateDE
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2021046796
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: