Provider Demographics
NPI:1689931677
Name:WANT, ASHTON BROOKE (PA-C)
Entity type:Individual
Prefix:MS
First Name:ASHTON
Middle Name:BROOKE
Last Name:WANT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1811 MEDICAL PKWY
Mailing Address - Street 2:APT 711
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-7521
Mailing Address - Country:US
Mailing Address - Phone:405-694-5100
Mailing Address - Fax:
Practice Address - Street 1:3900 JUNIUS ST
Practice Address - Street 2:SUITE 500
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1615
Practice Address - Country:US
Practice Address - Phone:469-800-7200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-16
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA07784363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical