Healthcare Provider Details

I. General information

NPI: 1316857717
Provider Name (Legal Business Name): CASSIE GARDNER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2124 14TH ST
MERIDIAN MS
39301-4040
US

IV. Provider business mailing address

915 SMITH RD
UNION MS
39365-9219
US

V. Phone/Fax

Practice location:
  • Phone: 601-703-3752
  • Fax:
Mailing address:
  • Phone: 601-663-9238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number913110
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: