MEDICARE: ASHLIE NICHOLE SEALE PMHNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	226050	OK
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	1011545	TX

General Provider Information

NPI Number	:	1912509027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLIE NICHOLE SEALE PMHNP-BC

Provider Business Mailing Address
First Line	:	3256 LACKLAND RD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76116-5307
Country	:	US
Telephone Number	:	817-204-5278
Fax Number	:	817-616-4127

Provider Business Practice Location Address
First Line	:	3256 LACKLAND RD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76116-5307
Country	:	US
Telephone Number	:	817-204-5278
Fax Number	:	817-616-4127

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/13/2020
Last Update Date	:	03/26/2026

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