Healthcare Provider Details

I. General information

NPI: 1326459793
Provider Name (Legal Business Name): CASSANDRA ANN BRICKEY RN,IBCLC, RLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2014
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1999 E STONE DR STE 105
KINGSPORT TN
37660-4630
US

IV. Provider business mailing address

639 VENUS BRANCH LN
HILTONS VA
24258-6585
US

V. Phone/Fax

Practice location:
  • Phone: 423-930-8209
  • Fax:
Mailing address:
  • Phone: 423-930-8209
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number0001305003
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: