Individual
MS. MICKIE LYNN CASSIDY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LSA, CSFA
Contact information
Practice address
1822 W BRAKER LN # 81603, AUSTIN, TX 78758-3606
(512) 973-9222
Mailing address
701 JASE DR, COPPERAS COVE, TX 76522-4432
(512) 743-8787
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
SA00649
TX
363AS0400X
Surgical Physician Assistant
SA00649
TX
Other
Enumeration date
01/02/2013
Last updated
05/02/2023
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