Provider Demographics
NPI:1922009851
Name:DICKERSON, CASSANDRA NASH (MD,FAAP)
Entity type:Individual
Prefix:DR
First Name:CASSANDRA
Middle Name:NASH
Last Name:DICKERSON
Suffix:
Gender:F
Credentials:MD,FAAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:4760 SWEETWATER BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-3148
Mailing Address - Country:US
Mailing Address - Phone:281-491-5439
Mailing Address - Fax:281-240-0577
Practice Address - Street 1:4760 SWEETWATER BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-3148
Practice Address - Country:US
Practice Address - Phone:281-491-5439
Practice Address - Fax:281-240-0577
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXK7434208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH20315Medicare UPIN