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General NPI Number Information
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NPI Number | 1871064352
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Entity Type | Individual
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Provider Name | CASSANDRA SMITH PAC
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Gender | Female
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Dates
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Enumeration Date | 12/10/2018
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Last Update Date | 10/27/2025
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Provider Practice Location Address
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Address Line | 111 VISION PARK BLVD STE 100
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City | SHENANDOAH
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State | TX
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Zip | 77384-3003
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Country | US
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Telephone | 713-714-1399
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Fax |
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Provider Business Mailing Address
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Address Line | 14296 ASPEN VALLEY DR
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City | CONROE
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State | TX
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Zip | 77384-1518
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Country | US
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Telephone | 724-953-2901
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA17102
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License Number State | TX
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