Healthcare Provider Details

I. General information

NPI: 1437082575
Provider Name (Legal Business Name): KASSANDRA PERRYMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8675 N LOXLEY RD
ROSCOMMON MI
48653-9568
US

IV. Provider business mailing address

8675 N LOXLEY RD
ROSCOMMON MI
48653-9568
US

V. Phone/Fax

Practice location:
  • Phone: 760-641-8843
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: