Provider Demographics
NPI:1063938306
Name:CHAPUT, CASSONDRA (PA-C)
Entity type:Individual
Prefix:MRS
First Name:CASSONDRA
Middle Name:
Last Name:CHAPUT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:CASSONDRA
Other - Middle Name:
Other - Last Name:HINKLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:810 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:KY
Mailing Address - Zip Code:42220-8812
Mailing Address - Country:US
Mailing Address - Phone:270-265-5600
Mailing Address - Fax:270-265-5605
Practice Address - Street 1:810 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:KY
Practice Address - Zip Code:42220-8812
Practice Address - Country:US
Practice Address - Phone:270-265-5600
Practice Address - Fax:270-265-5605
Is Sole Proprietor?:No
Enumeration Date:2017-08-18
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTC114363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical