Provider Demographics
NPI:1295126381
Name:CASON, DEANNA JADE (FNP)
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:JADE
Last Name:CASON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 N RIDGEWAY DR
Mailing Address - Street 2:
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76033-4115
Mailing Address - Country:US
Mailing Address - Phone:817-556-4800
Mailing Address - Fax:817-774-5015
Practice Address - Street 1:220 N RIDGEWAY DR
Practice Address - Street 2:
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033-4115
Practice Address - Country:US
Practice Address - Phone:817-556-4800
Practice Address - Fax:817-774-5015
Is Sole Proprietor?:No
Enumeration Date:2015-02-10
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP127335363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX344485301Medicaid