Provider Demographics
NPI:1174086805
Name:NASH, ADRIENNE FAYETTE (APRN, ACNPC-AG)
Entity type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:FAYETTE
Last Name:NASH
Suffix:
Gender:F
Credentials:APRN, ACNPC-AG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5103 KYLE CENTER DR STE 104
Mailing Address - Street 2:
Mailing Address - City:KYLE
Mailing Address - State:TX
Mailing Address - Zip Code:78640-6164
Mailing Address - Country:US
Mailing Address - Phone:512-504-0893
Mailing Address - Fax:
Practice Address - Street 1:5103 KYLE CENTER DR STE 104
Practice Address - Street 2:
Practice Address - City:KYLE
Practice Address - State:TX
Practice Address - Zip Code:78640-6164
Practice Address - Country:US
Practice Address - Phone:512-504-0893
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-10
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP141241363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care