Healthcare Provider Details

I. General information

NPI: 1063007714
Provider Name (Legal Business Name): ASHLEY BRAZWELL MSN, RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2021
Last Update Date: 08/10/2023
Certification Date: 08/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 ROAD TO SIX FLAGS W STE 128
ARLINGTON TX
76012-2600
US

IV. Provider business mailing address

1301 E DEBBIE LN STE 102
MANSFIELD TX
76063-3376
US

V. Phone/Fax

Practice location:
  • Phone: 903-326-3223
  • Fax:
Mailing address:
  • Phone: 903-326-3223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number834021
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number834021
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: