=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952582256
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CASSANDRA DINGUS, FNP, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/15/2007
-----------------------------------------------------
Last Update Date | 04/09/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 205 E 19TH ST N
-----------------------------------------------------
City | BIG STONE GAP
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24219-3468
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 276-524-4920
-----------------------------------------------------
Fax | 276-524-1401
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 205 E 19TH ST N
-----------------------------------------------------
City | BIG STONE GAP
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24219-3468
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 276-524-4920
-----------------------------------------------------
Fax | 276-524-1401
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PROVIDER/OWNER
-----------------------------------------------------
Name | CASSANDRA R DINGUS
-----------------------------------------------------
Credential | RN, MSN, FNP
-----------------------------------------------------
Telephone | 276-524-4920
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number | 0101045541
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------