Healthcare Provider Details

I. General information

NPI: 1316892516
Provider Name (Legal Business Name): CASSIE LEE LYELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2026
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1109 JONES ST
KENNETT MO
63857-3824
US

IV. Provider business mailing address

1109 JONES ST
KENNETT MO
63857-3824
US

V. Phone/Fax

Practice location:
  • Phone: 573-888-5925
  • Fax:
Mailing address:
  • Phone: 573-888-5925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: