Healthcare Provider Details

I. General information

NPI: 1770312993
Provider Name (Legal Business Name): CASSIE LYNN DELAWDER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2024
Last Update Date: 04/14/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 SUNCREST TOWN CENTRE DR
MORGANTOWN WV
26505-0589
US

IV. Provider business mailing address

600 SUNCREST TOWN CENTRE DR
MORGANTOWN WV
26505-0589
US

V. Phone/Fax

Practice location:
  • Phone: 855-988-2273
  • Fax:
Mailing address:
  • Phone: 304-598-4855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number105154
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: