Individual
JASON PRICKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
6606 LBJ FWY, SUITE 200, DALLAS, TX 75240-6533
(972) 715-5000
(972) 715-9976
Mailing address
PO BOX 650865, DALLAS, TX 75265-0865
(972) 715-5000
(972) 715-9976
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
51446263102
UT
163W00000X
Registered Nurse
878376
TX
367500000X
Certified Registered Nurse Anesthetist
Primary
AP128298
TX
367500000X
Certified Registered Nurse Anesthetist
APN0000018814
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8875UK
BCBS
TX
Enumeration date
06/17/2014
Last updated
08/02/2021
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