Provider Demographics
NPI:1194690016
Name:HENRY, CASSANDRA LACOLE
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:LACOLE
Last Name:HENRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 32
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:71845-0032
Mailing Address - Country:US
Mailing Address - Phone:870-953-1630
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 32
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:AR
Practice Address - Zip Code:71845-0032
Practice Address - Country:US
Practice Address - Phone:870-953-1630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-09
Last Update Date:2025-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty