Healthcare Provider Details

I. General information

NPI: 1982861621
Provider Name (Legal Business Name): TOMMIE ANN CASSIDY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2008
Last Update Date: 09/30/2021
Certification Date: 09/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 11TH ST NE
SPRINGHILL LA
71075
US

IV. Provider business mailing address

401 11TH N.E.
SPRINGHILL LA
71075-4503
US

V. Phone/Fax

Practice location:
  • Phone: 318-539-7101
  • Fax: 318-539-1731
Mailing address:
  • Phone: 318-539-1701
  • Fax: 318-539-1731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number05547
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: