Provider Demographics
NPI:1447062138
Name:GARRETT, KASSANDRA LYNN
Entity type:Individual
Prefix:
First Name:KASSANDRA
Middle Name:LYNN
Last Name:GARRETT
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 1:1941 S 42ND ST STE 129
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68105-2938
Mailing Address - Country:US
Mailing Address - Phone:402-515-1768
Mailing Address - Fax:
Practice Address - Street 1:1941 S 42ND ST STE 129
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68105-2938
Practice Address - Country:US
Practice Address - Phone:402-515-1768
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-21
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider