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General NPI Number Information
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NPI Number | 1740131432
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Entity Type | Individual
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Provider Name | KASANDRA KAY WILMORE CCRN
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Gender | Female
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Dates
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Enumeration Date | 02/07/2026
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Last Update Date | 02/07/2026
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Provider Practice Location Address
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Address Line | 1 MEDICAL BLVD
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City | COOKEVILLE
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State | TN
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Zip | 38505-0001
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Country | US
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Telephone | 931-783-5032
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Fax |
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Provider Business Mailing Address
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Address Line | 108 STANDING ROCK RD
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City | DEER LODGE
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State | TN
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Zip | 37726-3818
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Country | US
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Telephone | 931-704-1607
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 269330
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License Number State | TN
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