Kassie Idicula, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA08972 Issued in TX

Practice address

2412 50TH St
Lubbock, TX 79412-2504

Phone

(806) 744-7223

Fax

(806) 740-3325

NPI assigned

Apr 30, 2014

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Kassie Nicole Quintana Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Jason a Ramsey Mdpa Sportszone Orthopedics

  • Orthopaedic Surgery Physician
  • Lubbock, TX
  • NPI 1801401229
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1398816000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1413158400000",
    "number": "1952711947",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2804 N LOOP 289",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794151410",
            "telephone_number": "806-744-7223",
            "fax_number": "806-740-3325"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2412 50TH ST",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794122504",
            "telephone_number": "806-744-7223",
            "fax_number": "806-740-3325"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IDICULA",
        "first_name": "KASSIE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-04-30",
        "last_updated": "2014-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA08972",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KASSIE",
            "last_name": "QUINTANA",
            "middle_name": "NICOLE",
            "credential": "PA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• John Iacuone, M.D.
• Kyshondra Ibarra
• Yasin Ibrahim
• Roberto Hwang Ico, P.T.
• Anceslo Idicula, MD
• Winslo K Idicula, M.D.
• Usiakimi Igbaseimokumo, MBBS, FRCS(C), MD
• Andrew Igbokwe, DO
• Igneous Dental PLLC
• Igor Siniakov, M.D., P.a.

• Physician Assistant in Lubbock, TX
• Providers in Lubbock, TX by specialty
• Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.