Basic Information
| Provider Information | |||||||||
| NPI: | 1720675176 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TRUELOVE | ||||||||
| FirstName: | KASSIE | ||||||||
| MiddleName: | NICOLE | ||||||||
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| Credential: | CRNA, DNP-A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4824 7TH ST | ||||||||
| Address2: | |||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 794164921 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8067890351 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3601 4TH ST | ||||||||
| Address2: | |||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 794300002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8067432669 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/30/2020 | ||||||||
| LastUpdateDate: | 11/22/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 131078 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.