Provider Demographics
NPI:1487647095
Name:SMITH, CASSANDRA ANN (CRNA)
Entity type:Individual
Prefix:MS
First Name:CASSANDRA
Middle Name:ANN
Last Name:SMITH
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MS
Other - First Name:CASSANDRA
Other - Middle Name:ANN
Other - Last Name:MACHADO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 632572
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-2572
Mailing Address - Country:US
Mailing Address - Phone:859-341-2666
Mailing Address - Fax:859-341-7867
Practice Address - Street 1:1 MEDICAL VILLAGE DR
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017-3403
Practice Address - Country:US
Practice Address - Phone:859-301-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-30
Last Update Date:2025-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3014583367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA120420418OtherDEPT OF LABOR
PAG9200081 85XWCUOtherCAREFIRST
PAP00458420OtherRAILROAD MEDICARE
PA253420OtherUNISON
PAPEARL PROVIDEROtherHEALTH AMERICA
PA50073153OtherCAPITAL BLUECROSS
PA1007307260035OtherMEDICAID GROUP #
PA25-1716306OtherINTERGROUP
PA25-1716306OtherMULTIPLAN/PHCS
PA25-1716306OtherHEALTHNET/TRICARE
PARN283908LOtherLICENSE
PA050514OtherGROUP MEDICARE #
PA101291255Medicaid
PAP00458420OtherRAILROAD MEDICARE