Basic Information
| Provider Information | |||||||||
| NPI: | 1952775819 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEEPER | ||||||||
| FirstName: | CASSANDRA | ||||||||
| MiddleName: | ANNE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | MS, RDN, LD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5508 111TH ST | ||||||||
| Address2: | |||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 794247572 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8307961810 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6104 AVENUE Q SOUTH DR | ||||||||
| Address2: | |||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 794123700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8064723400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2015 | ||||||||
| LastUpdateDate: | 11/16/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | DT83417 | TX | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.