Healthcare Provider Details

I. General information

NPI: 1144892902
Provider Name (Legal Business Name): CASSIDY WALKER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2021
Last Update Date: 07/12/2021
Certification Date: 07/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 S LAKEPORT ST
SIOUX CITY IA
51106-4222
US

IV. Provider business mailing address

520 5TH ST
SLOAN IA
51055-7704
US

V. Phone/Fax

Practice location:
  • Phone: 712-277-4442
  • Fax:
Mailing address:
  • Phone: 712-389-6410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF06211168
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: