Provider Demographics
NPI:1124638887
Name:CASSITY, ANGIE (MEDES)
Entity type:Individual
Prefix:
First Name:ANGIE
Middle Name:
Last Name:CASSITY
Suffix:
Gender:F
Credentials:MEDES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8200 E THORN DR
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-2709
Mailing Address - Country:US
Mailing Address - Phone:316-719-3299
Mailing Address - Fax:316-719-1296
Practice Address - Street 1:8200 E THORN DR
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-2709
Practice Address - Country:US
Practice Address - Phone:316-719-3299
Practice Address - Fax:316-719-1296
Is Sole Proprietor?:No
Enumeration Date:2020-08-06
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator