Healthcare Provider Details

I. General information

NPI: 1225388671
Provider Name (Legal Business Name): CASSI MACRAE DESKINS FNPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CASSI MACRAE EASTON

II. Dates (important events)

Enumeration Date: 09/13/2012
Last Update Date: 09/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 E EVERGREEN
CAMERON MO
64429
US

IV. Provider business mailing address

1600 E EVERGREEN
CAMERON MO
64429
US

V. Phone/Fax

Practice location:
  • Phone: 816-632-2101
  • Fax: 816-649-3383
Mailing address:
  • Phone: 816-632-2101
  • Fax: 816-649-3383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2006006025
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: