1780413625 NPI number — CASSANDRA ALEXIS NOLDER AU.D., CCC-A

NPI Number: 1780413625
Health Care Provider/Practitioner: CASSANDRA ALEXIS NOLDER AU.D., CCC-A

NPI Number : 1780413625 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1780413625",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "NOLDER",
    "FirstName": "CASSANDRA",
    "MiddleName": "ALEXIS",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "AU.D., CCC-A",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "HECK",
    "OtherFirstName": "CASSANDRA",
    "OtherMiddleName": "ALEXIS",
    "OtherNamePrefix": "DR.",
    "OtherNameSuffix": null,
    "OtherCredential": "AU.D., CCC-A",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "11767 S DIXIE HWY # 122",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "PINECREST",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "33156-4438",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "346-291-2206",
    "MailingAddressFaxNumber": "346-291-2206",
    "FirstLinePracticeLocationAddress": "6242 POPLAR AVE STE 1",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MEMPHIS",
    "PracticeLocationAddressStateName": "TN",
    "PracticeLocationAddressPostalCode": "38119-4730",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "901-842-4327",
    "PracticeLocationAddressFaxNumber": "901-842-4330",
    "EnumerationDate": "07/30/2024",
    "LastUpdateDate": "09/17/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "231H00000X",
          "TaxonomyName": "Audiologist",
          "LicenseNumber": "AY2835",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "231H00000X",
          "TaxonomyName": "Audiologist",
          "LicenseNumber": "2283",
          "LicenseNumberStateCode": "TN",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}