Cassidy Jo Koons
Student in an Organized Health Care Education/Training Program in Kendallville, IN. Individual provider (NPI-1).
NPI number1063207751
StatusActive
Last updated in NPPESApr 12, 2025
Details
- NPI
- 1063207751
- Entity type
- Individual (NPI-1)
- Name
- Mrs. Cassidy Jo Koons
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Apr 12, 2025
- Certification date
- Apr 12, 2025
- Last updated
- Apr 12, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 390200000X | Student in an Organized Health Care Education/Training Program | – | – | Yes |
Practice location
415 Drake RdKendallville, IN 46755-2007
Phone 260-347-0100
Mailing address
415 Drake RdKendallville, IN 46755-2007
Phone 260-347-0100 · Fax 260-347-7168
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