Individual
MS. KASSANDRA ALYSABETH MELLOTT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
220 ESSIE DAVISON DR, CLARINDA, IA 51632-2915
(712) 542-2176
(712) 542-8311
Mailing address
PO BOX 217, CLARINDA, IA 51632-0217
(712) 542-2176
(712) 542-8311
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
2237
NE
363A00000X
Physician Assistant
085452
IA
363A00000X
Physician Assistant
Primary
2237
NE
Other
Enumeration date
01/23/2017
Last updated
05/04/2022
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