Healthcare Provider Details

I. General information

NPI: 1508147844
Provider Name (Legal Business Name): CASSIE ALEXANDER ACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2011
Last Update Date: 01/18/2024
Certification Date: 01/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 15TH ST # BP-3448
AUGUSTA GA
30912-0004
US

IV. Provider business mailing address

5025 FARMSTONE CT
EVANS GA
30809-6077
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-4043
  • Fax:
Mailing address:
  • Phone: 706-495-2879
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberRN140383
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License NumberRN140383
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: