| Doctor Name: | MS. MICKIE LYNN CASSIDY |
| NPI Number: | 1033455530 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CSFA |
| License Number: | 139270 |
| Business Practice Address: | 701 Jase Dr Copperas Cove, TX - 765224432 |
| Business Phone Number: | 5127438787 |
| Business Fax Number: | |
| Mailing Address: | 701 Jase Dr, COPPERAS COVE |
| State: | TX |
| Postal Code: | 765224432 |
| Phone Number: | 5127438787 |
| Fax Number: | |
| NPI Enumeration Date: | 01/02/2013 |
| NPI Last Update Date: | 01/08/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AS0400X |
| License Number: | 139270 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | TX |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Surgical |
| Taxonomy Definition: | |