Provider Demographics
NPI:1861433609
Name:ASWELL, CHARLES (CRNA)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:ASWELL
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 841656
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-1656
Mailing Address - Country:US
Mailing Address - Phone:903-531-5000
Mailing Address - Fax:
Practice Address - Street 1:800 E DAWSON ST
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-2036
Practice Address - Country:US
Practice Address - Phone:903-606-4522
Practice Address - Fax:865-541-2787
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11871367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP00285225OtherMEDICARE TRAVELERS
TXP01938569OtherMEDICARE RAIL ROAD
TN3636288Medicaid
TN4121475OtherBLUECARE
TX616376YQ8AOtherMEDICARE
TX723877OtherMEDICARE
TX75-0818167-015OtherTRICARE
TX379954603Medicaid
TN4121475OtherBLUE CROSS
TXP02136788OtherMEDICARE RAIL ROAD
TX379954601Medicaid
TX8HB331OtherBCBS
TN100050404OtherPHP TENNCARE
TX8JN057OtherBCBS