Provider Demographics
NPI:1184349037
Name:NASH, RAYNELLE (PA)
Entity type:Individual
Prefix:
First Name:RAYNELLE
Middle Name:
Last Name:NASH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:ID# 2163
Mailing Address - Street 2:PO BOX 659506
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78265-9506
Mailing Address - Country:US
Mailing Address - Phone:210-878-4116
Mailing Address - Fax:210-878-4113
Practice Address - Street 1:18626 HARDY OAK BLVD STE 101
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4218
Practice Address - Country:US
Practice Address - Phone:210-878-4116
Practice Address - Fax:210-878-4113
Is Sole Proprietor?:No
Enumeration Date:2022-10-04
Last Update Date:2022-10-04
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical