Provider Demographics
NPI:1063046811
Name:BOEHNING, CASSANDRA A (FNP-C)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:A
Last Name:BOEHNING
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:CASSANDRA
Other - Middle Name:
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2790 CLAY EDWARDS DR STE 530
Mailing Address - Street 2:
Mailing Address - City:NORTH KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64116-3266
Mailing Address - Country:US
Mailing Address - Phone:816-452-3300
Mailing Address - Fax:816-453-0677
Practice Address - Street 1:4745 OGLETOWN STANTON RD STE 105
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2070
Practice Address - Country:US
Practice Address - Phone:302-368-3257
Practice Address - Fax:302-368-3237
Is Sole Proprietor?:No
Enumeration Date:2020-03-02
Last Update Date:2024-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL1-0055770163W00000X
DELG-0001394363LF0000X
MO2021046796363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse