Basic Information
| Provider Information | |||||||||
| NPI: | 1649607656 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PARRA-FERRO | ||||||||
| FirstName: | CASSANDRA | ||||||||
| MiddleName: | NICOLE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 WELLNESS BLVD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | IRMO | ||||||||
| State: | SC | ||||||||
| PostalCode: | 290632871 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8037491111 | ||||||||
| FaxNumber: | 8037490050 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 WELLNESS BLVD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | IRMO | ||||||||
| State: | SC | ||||||||
| PostalCode: | 290632871 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8037491111 | ||||||||
| FaxNumber: | 8037490050 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2013 | ||||||||
| LastUpdateDate: | 11/27/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | MP3064576 | 01 | SC | DEA | OTHER | MPA2004 PA | 01 | SC | SC MEDICAL LICENSE | OTHER |