Provider Demographics
NPI:1053185686
Name:KING, CASSANDRA LEE (FNP-BC)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:LEE
Last Name:KING
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3210 TRAFFIC WAY
Mailing Address - Street 2:
Mailing Address - City:ATASCADERO
Mailing Address - State:CA
Mailing Address - Zip Code:93422-2602
Mailing Address - Country:US
Mailing Address - Phone:805-234-4823
Mailing Address - Fax:
Practice Address - Street 1:820 CA-88
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:CA
Practice Address - Zip Code:95642
Practice Address - Country:US
Practice Address - Phone:209-223-7040
Practice Address - Fax:209-223-7606
Is Sole Proprietor?:No
Enumeration Date:2023-11-14
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95027499363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily