Provider Demographics
NPI:1285265504
Name:NOONAN, CASSANDRA ALYSE (PA)
Entity type:Individual
Prefix:MS
First Name:CASSANDRA
Middle Name:ALYSE
Last Name:NOONAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MRS
Other - First Name:CASSANDRA
Other - Middle Name:ALYSE
Other - Last Name:RIVERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:17189 INTERSTATE HIGHWAY 45 SOUTH
Mailing Address - Street 2:SUITE 675
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77385
Mailing Address - Country:US
Mailing Address - Phone:936-270-3905
Mailing Address - Fax:
Practice Address - Street 1:17189 INTERSTATE HIGHWAY 45 SOUTH
Practice Address - Street 2:SUITE 675
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77385
Practice Address - Country:US
Practice Address - Phone:936-270-3905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-27
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX363AM0700X
TXPA13502363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA13502OtherTEXAS MEDICAL BOARD