MEDICARE: KASSANDRA LARISSA AGUNDIZ NP

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	363L00000X	Nurse Practitioner	1010989	TX

General Provider Information

NPI Number	:	1902757495
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KASSANDRA LARISSA AGUNDIZ NP

Provider Business Mailing Address
First Line	:	108 WILLOW OAK DR
Second Line	:
City	:	KRUGERVILLE
State	:	TX
Zip	:	76227-2649
Country	:	US
Telephone Number	:	469-732-7171
Fax Number	:

Provider Business Practice Location Address
First Line	:	4709 W PARKER RD STE 420
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-3369
Country	:	US
Telephone Number	:	469-732-7171
Fax Number	:

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

Provider Enumeration Date	:	02/09/2026
Last Update Date	:	02/10/2026

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