Provider Demographics
NPI:1124867056
Name:JESSIE-JOHNSON, CASSANDRA (CBS)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:JESSIE-JOHNSON
Suffix:
Gender:F
Credentials:CBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1903 22ND ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-8953
Mailing Address - Country:US
Mailing Address - Phone:510-228-8103
Mailing Address - Fax:
Practice Address - Street 1:1903 22ND ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-8953
Practice Address - Country:US
Practice Address - Phone:510-228-8103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-21
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula