Active NPI
Cassie Lee Gonzales, APN
- Family Nurse Practitioner
- Texarkana, TX
National Provider Identifier
1306169701
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- R73142
- Practice address
- 2602 Saint Michael Dr
Texarkana, TX 75503-2387 - Phone
- (903) 614-5090
- NPI assigned
- Mar 12, 2010
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | R73142 | TX | Primary |
Addresses
Primary practice location
2602 Saint Michael Dr
Texarkana, TX 75503-2387
Mailing address
2100 Powell St Ste 900
Emeryville, CA 94608-1844
Phone (510) 350-2600
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
- Opted out of Medicare
- Yes, effective Oct 1, 2017 through Oct 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R73142 | TX | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1268352000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1268352000000",
"number": "1306169701",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2100 POWELL ST STE 900",
"city": "EMERYVILLE",
"state": "CA",
"postal_code": "946081844",
"telephone_number": "510-350-2600",
"fax_number": "510-879-9100"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2602 SAINT MICHAEL DR",
"city": "TEXARKANA",
"state": "TX",
"postal_code": "755032387",
"telephone_number": "903-614-5090"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GONZALES",
"first_name": "CASSIE",
"middle_name": "LEE",
"credential": "APN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-03-12",
"last_updated": "2010-03-12",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "TX",
"license": "R73142",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Texarkana, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.