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NPI Code Detail

MEDICARE: RONNIE DALE NASH PA

MEDICARE: RONNIE DALE NASH PA
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
1363AM0700XMedical Physician AssistantPA07329TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
175-2616977-028OTHERTXTRICARE
2851N93OTHERTXBCBS
375-2616977-001OTHERTXTRICARE
475-2616977-002OTHERTXTRICARE
5752616977001OTHERTXTRICARE
6752616977002OTHERTXTRICARE
7MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
875-2616977-041OTHERTXTRICARE

General Provider Information

NPI Number : 1790073435
Entity Type Code : Individual
Provider Name (Legal Business Name) : RONNIE DALE NASH PA
Provider Business Mailing Address
First Line : PO BOX 846098
Second Line :
City : DALLAS
State : TX
Zip : 75284-6098
Country : US
Telephone Number : 903-324-6450
Fax Number :
Provider Business Practice Location Address
First Line : 20208 STATE HIGHWAY 155 S
Second Line :
City : FLINT
State : TX
Zip : 75762-5600
Country : US
Telephone Number : 903-825-6222
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/15/2011
Last Update Date : 10/13/2014

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1609138486 — TIMOTHY L HOLCOMB D.O.
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Directions to “ RONNIE DALE NASH PA” Practice Location

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