Healthcare Provider Details

I. General information

NPI: 1982898326
Provider Name (Legal Business Name): CASSANDRA L LUTES APRN,FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2007
Last Update Date: 06/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 HIGHWAY AA
TROY MO
63379
US

IV. Provider business mailing address

215 HIGHWAY AA
TROY MO
63379-4423
US

V. Phone/Fax

Practice location:
  • Phone: 636-295-1009
  • Fax:
Mailing address:
  • Phone: 636-295-1009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2000158996
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number2000158996
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number2000158996
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License Number2000158996
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: