Provider Demographics
NPI:1063612190
Name:MAXWELL, CASSANDA HOWELL (CPNP)
Entity type:Individual
Prefix:
First Name:CASSANDA
Middle Name:HOWELL
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 HIGHWAY 80
Mailing Address - Street 2:
Mailing Address - City:HAUGHTON
Mailing Address - State:LA
Mailing Address - Zip Code:71037-7425
Mailing Address - Country:US
Mailing Address - Phone:318-949-0539
Mailing Address - Fax:318-949-0759
Practice Address - Street 1:1025 HIGHWAY 80
Practice Address - Street 2:
Practice Address - City:HAUGHTON
Practice Address - State:LA
Practice Address - Zip Code:71037-7425
Practice Address - Country:US
Practice Address - Phone:318-949-0539
Practice Address - Fax:318-949-0759
Is Sole Proprietor?:No
Enumeration Date:2007-07-18
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP05255363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1016534Medicaid