Provider Demographics
NPI:1669364170
Name:AMSHOFF, CASSANDRA NICOLE (PA)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:NICOLE
Last Name:AMSHOFF
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2713 FLAT ROCK RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40245-4862
Mailing Address - Country:US
Mailing Address - Phone:502-974-1863
Mailing Address - Fax:
Practice Address - Street 1:6641 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40258-3909
Practice Address - Country:US
Practice Address - Phone:502-364-0902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-18
Last Update Date:2025-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTC136363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant