Provider Demographics
NPI:1932716156
Name:MEYNARD, CASSIE RENEE
Entity type:Individual
Prefix:
First Name:CASSIE
Middle Name:RENEE
Last Name:MEYNARD
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 1:101A BUFFALO RUN
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-6605
Mailing Address - Country:US
Mailing Address - Phone:337-254-0828
Mailing Address - Fax:
Practice Address - Street 1:1100 BERTRAND DR # A
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-4110
Practice Address - Country:US
Practice Address - Phone:337-315-6474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-01
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN144734163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse