MEDICARE: KASANDRA IBARRA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WX0003X	Inpatient Obstetric Registered Nurse	1006220	TX
2	367A00000X	Advanced Practice Midwife	1093508822	TX

General Provider Information

NPI Number	:	1093508822
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KASANDRA IBARRA

Provider Business Mailing Address
First Line	:	1425 PECOS ST.
Second Line	:
City	:	MESQUITE
State	:	TX
Zip	:	75150
Country	:	US
Telephone Number	:	214-259-5396
Fax Number	:

Provider Business Practice Location Address
First Line	:	1425 PECOS ST.
Second Line	:
City	:	MESQUITE
State	:	TX
Zip	:	75150
Country	:	US
Telephone Number	:	214-259-5396
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2025
Last Update Date	:	02/05/2026

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Directions to “ KASANDRA IBARRA ” Practice Location

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