Provider Demographics
NPI:1922168525
Name:WHITSON, TRICIA L (CRNA)
Entity Type:Individual
Prefix:
First Name:TRICIA
Middle Name:L
Last Name:WHITSON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:TRICIA
Other - Middle Name:L
Other - Last Name:DESABRAIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 733784
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3784
Mailing Address - Country:US
Mailing Address - Phone:682-885-1855
Mailing Address - Fax:682-885-1396
Practice Address - Street 1:801 7TH AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2733
Practice Address - Country:US
Practice Address - Phone:682-885-4045
Practice Address - Fax:682-885-7497
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX641654367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX10006754OtherAMERIGROUP PIN
TX137345809OtherMEDICAID GROUP TPI
TX140442853OtherCSHCN GROUP TPI
1447220850OtherGRP NPI NUMBER
TX150257703Medicaid
TX150257704OtherCSHCN
TX2256747OtherUHC PIN
TX150257703Medicaid