Provider Demographics
NPI:1871052472
Name:CARR, CASSIDY ALANA (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:CASSIDY
Middle Name:ALANA
Last Name:CARR
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 COURT STREET
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51101-1919
Mailing Address - Country:US
Mailing Address - Phone:712-252-3871
Mailing Address - Fax:712-252-3157
Practice Address - Street 1:625 COURT STREET
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51101-1919
Practice Address - Country:US
Practice Address - Phone:712-252-3871
Practice Address - Fax:712-252-3157
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-14
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA127714163W00000X
IAG159688363LP0808X, 364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA127714Medicaid