Healthcare Provider Details

I. General information

NPI: 1487527511
Provider Name (Legal Business Name): CASSI PREWITT LAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2025
Last Update Date: 09/25/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

616 CAL YOUNG
HALLSVILLE TX
75650
US

IV. Provider business mailing address

1471 TOM SMITH RD
HARLETON TX
75651-4939
US

V. Phone/Fax

Practice location:
  • Phone: 903-668-5990
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT9308
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: