Individual
CARLEY CASSITY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
12301 WILSHIRE BLVD STE 315, LOS ANGELES, CA 90025-1053
(424) 325-3368
Mailing address
12301 WILSHIRE BLVD STE 315, LOS ANGELES, CA 90025-1053
(424) 325-3368
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
95026507
CA
363L00000X
Nurse Practitioner
Primary
1588162556
CA
363LP2300X
Primary Care Nurse Practitioner
1588162556
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1132042
RN LICENSE KY
KY
01
—
95026507
RN LICENSE CALIFORNIA
CA
01
—
F01180305
FNP CERTIFICATION
CA
Enumeration date
01/25/2018
Last updated
09/28/2023
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