=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316429434
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CASSIE L. AUSTIN FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/05/2018
-----------------------------------------------------
Last Update Date | 09/19/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1902B JACKSON AVE W
-----------------------------------------------------
City | OXFORD
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38655-4206
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-234-6464
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 970 HIGHWAY 7 S
-----------------------------------------------------
City | WATER VALLEY
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38965-3746
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-832-4477
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | F09180077
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 902883
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | F09180077
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------