Provider Demographics
NPI:1689002081
Name:NASH, DAVID (NURSE PRACTITONER)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:NASH
Suffix:
Gender:M
Credentials:NURSE PRACTITONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5409
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79608-5409
Mailing Address - Country:US
Mailing Address - Phone:325-437-8642
Mailing Address - Fax:
Practice Address - Street 1:1665 ANTILLEY RD STE 240
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-5274
Practice Address - Country:US
Practice Address - Phone:325-437-8642
Practice Address - Fax:325-437-8698
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-22
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP124590363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX329805101Medicaid