Provider Demographics
NPI:1003701178
Name:HARRELSON, KASSIDY BROOKE
Entity type:Individual
Prefix:
First Name:KASSIDY
Middle Name:BROOKE
Last Name:HARRELSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3804 COUNTY ROAD 2546
Mailing Address - Street 2:
Mailing Address - City:QUINLAN
Mailing Address - State:TX
Mailing Address - Zip Code:75474-7816
Mailing Address - Country:US
Mailing Address - Phone:469-714-7676
Mailing Address - Fax:
Practice Address - Street 1:3804 COUNTY ROAD 2546
Practice Address - Street 2:
Practice Address - City:QUINLAN
Practice Address - State:TX
Practice Address - Zip Code:75474-7816
Practice Address - Country:US
Practice Address - Phone:469-714-7676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-10
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer