Healthcare Provider Details

I. General information

NPI: 1528208824
Provider Name (Legal Business Name): CASSANDRA D STOREY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2009
Last Update Date: 01/16/2025
Certification Date: 01/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 COLLEGE DR BLDG 700
WELDON NC
27890-1121
US

IV. Provider business mailing address

PO BOX 640
ROANOKE RAPIDS NC
27870-0640
US

V. Phone/Fax

Practice location:
  • Phone: 252-578-8685
  • Fax: 252-308-1864
Mailing address:
  • Phone: 252-536-5844
  • Fax: 252-519-0154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110004112
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number001001636
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: