MEDICARE: CASSIDY WHEELER DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1922702596
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASSIDY WHEELER DO

Provider Business Mailing Address
First Line	:	7721 WHISTERWHEEL WAY
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76123-2683
Country	:	US
Telephone Number	:	832-771-4486
Fax Number	:

Provider Business Practice Location Address
First Line	:	7721 WHISTERWHEEL WAY
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76123-2683
Country	:	US
Telephone Number	:	832-771-4486
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2023
Last Update Date	:	05/04/2026

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Directions to “ CASSIDY WHEELER DO” Practice Location

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