Healthcare Provider Details

I. General information

NPI: 1720697402
Provider Name (Legal Business Name): CASSIE LYNN MCCARTHY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2020
Last Update Date: 11/25/2022
Certification Date: 11/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 N WALDRON ST
HUTCHINSON KS
67502-1197
US

IV. Provider business mailing address

2101 N WALDRON ST
HUTCHINSON KS
67502-1197
US

V. Phone/Fax

Practice location:
  • Phone: 620-669-2500
  • Fax:
Mailing address:
  • Phone: 620-669-2500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number53-81407
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number135437
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: