Provider Demographics
NPI:1588162556
Name:CASSITY, CARLEY (NP)
Entity type:Individual
Prefix:
First Name:CARLEY
Middle Name:
Last Name:CASSITY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12301 WILSHIRE BLVD STE 315
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-1053
Mailing Address - Country:US
Mailing Address - Phone:424-325-3368
Mailing Address - Fax:
Practice Address - Street 1:12301 WILSHIRE BLVD STE 315
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-1053
Practice Address - Country:US
Practice Address - Phone:424-325-3368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-25
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95026507163WG0000X
CA1588162556363LP2300X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95026507OtherRN LICENSE CALIFORNIA
CAF01180305OtherFNP CERTIFICATION
KY1132042OtherRN LICENSE KY