Provider Demographics
NPI:1598010829
Name:LUNA, CASSIDY JEANNETTE (NNP-BC)
Entity Type:Individual
Prefix:
First Name:CASSIDY
Middle Name:JEANNETTE
Last Name:LUNA
Suffix:
Gender:F
Credentials:NNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5219 CITY BANK PKWY
Mailing Address - Street 2:SUITE 35
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79407-3544
Mailing Address - Country:US
Mailing Address - Phone:806-782-0206
Mailing Address - Fax:
Practice Address - Street 1:6809 SLIDE RD
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-1517
Practice Address - Country:US
Practice Address - Phone:806-771-7257
Practice Address - Fax:806-788-0853
Is Sole Proprietor?:No
Enumeration Date:2012-07-24
Last Update Date:2019-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX758751363LN0000X
TXAP122355363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal