Healthcare Provider Details

I. General information

NPI: 1154766756
Provider Name (Legal Business Name): JASON S PREECE CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2013
Last Update Date: 05/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 WALLACE BLVD
AMARILLO TX
79106-1799
US

IV. Provider business mailing address

6111 DREYFUSS RD
AMARILLO TX
79106-3535
US

V. Phone/Fax

Practice location:
  • Phone: 806-212-2000
  • Fax:
Mailing address:
  • Phone: 801-458-6572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number835475
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: