Provider Demographics
NPI:1508875659
Name:RICO, KASSIDY NICOLE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KASSIDY
Middle Name:NICOLE
Last Name:RICO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:KASSIDY
Other - Middle Name:NICOLE
Other - Last Name:TODD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3900 JUNIUS ST
Mailing Address - Street 2:STE 500
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1615
Mailing Address - Country:US
Mailing Address - Phone:469-800-7200
Mailing Address - Fax:469-800-7210
Practice Address - Street 1:3900 JUNIUS ST
Practice Address - Street 2:STE 500
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1615
Practice Address - Country:US
Practice Address - Phone:469-800-7200
Practice Address - Fax:469-800-7210
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04605363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8N9334OtherBCBS
Q64234Medicare UPIN
TX8G3975Medicare PIN
TX442792YKTPMedicare PIN
TXP00859798Medicare PIN