Provider Demographics
NPI:1336191543
Name:ASHLEY, JASON T (CRNA)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:T
Last Name:ASHLEY
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 INTERNATIONAL PLZ
Mailing Address - Street 2:SUITE 600
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-4820
Mailing Address - Country:US
Mailing Address - Phone:817-529-1923
Mailing Address - Fax:817-877-0350
Practice Address - Street 1:2000 E LAMAR BLVD STE 400
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76006-7353
Practice Address - Country:US
Practice Address - Phone:817-861-3994
Practice Address - Fax:682-227-6869
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX643018367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX149462703Medicaid
TX149462703Medicaid