Provider Demographics
NPI:1528208824
Name:STOREY, CASSANDRA D (PA-C)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:D
Last Name:STOREY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 640
Mailing Address - Street 2:
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870-0640
Mailing Address - Country:US
Mailing Address - Phone:252-536-5844
Mailing Address - Fax:252-519-0154
Practice Address - Street 1:100 COLLEGE DR BLDG 700
Practice Address - Street 2:
Practice Address - City:WELDON
Practice Address - State:NC
Practice Address - Zip Code:27890-1121
Practice Address - Country:US
Practice Address - Phone:252-578-8685
Practice Address - Fax:252-308-1864
Is Sole Proprietor?:No
Enumeration Date:2009-02-26
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0110004112363A00000X
NC001001636363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant