Healthcare Provider Details

I. General information

NPI: 1912888421
Provider Name (Legal Business Name): CASSANDRA KEEL PRSS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2025
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 W CHARLESTON BLVD
LAS VEGAS NV
89102-2205
US

IV. Provider business mailing address

2121 W CHARLESTON BLVD
LAS VEGAS NV
89102-2205
US

V. Phone/Fax

Practice location:
  • Phone: 702-382-7746
  • Fax:
Mailing address:
  • Phone: 702-382-7746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberPRSS-5300
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: