Provider Demographics
NPI:1003428855
Name:BECERRA, KASSANDRA GUADALUPE (RN)
Entity Type:Individual
Prefix:
First Name:KASSANDRA
Middle Name:GUADALUPE
Last Name:BECERRA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 MCQUEARY ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012-3751
Mailing Address - Country:US
Mailing Address - Phone:972-513-4656
Mailing Address - Fax:
Practice Address - Street 1:600 MCQUEARY ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-3751
Practice Address - Country:US
Practice Address - Phone:972-513-4656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-21
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1000732163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse