Healthcare Provider Details

I. General information

NPI: 1740741834
Provider Name (Legal Business Name): CASSEY NELSON DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2019
Last Update Date: 02/12/2025
Certification Date: 02/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2750 SAINT FRANCIS DR
WATERLOO IA
50702-5644
US

IV. Provider business mailing address

250 PARK ST
BOWLING GREEN KY
42101-1760
US

V. Phone/Fax

Practice location:
  • Phone: 319-272-8922
  • Fax: 319-272-8929
Mailing address:
  • Phone: 270-780-2693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberIP1661
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberDO-06917
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: