Provider Demographics
NPI:1063154219
Name:KAUFMAN, CASSIE (PA)
Entity type:Individual
Prefix:
First Name:CASSIE
Middle Name:
Last Name:KAUFMAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4600 MERCY LN STE 220
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-3070
Mailing Address - Country:US
Mailing Address - Phone:479-347-3810
Mailing Address - Fax:479-338-3089
Practice Address - Street 1:4600 MERCY LN STE 220
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-3070
Practice Address - Country:US
Practice Address - Phone:479-347-3810
Practice Address - Fax:479-338-3089
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-08
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARPA-1072363A00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant