Kassie Idicula, PA

NPI #1952711947 in Lubbock, Texas

Provider Information

NPI Number: 1952711947
Entity Type: Individual
Name: Kassie Idicula, PA
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Physician Assistant
Credential: PA
Enumeration Date: Apr 30, 2014
Last Updated: Oct 13, 2014

Practice Location

Address: 2412 50TH ST
City: Lubbock
State: Texas
ZIP Code: 79412-2504
Phone: (806) 744-7223

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physician Assistant	363A00000X	Primary

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