Healthcare Provider Details

I. General information

NPI: 1649023995
Provider Name (Legal Business Name): ASHLEY RENEA THORUP CPM, LLM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2024
Last Update Date: 04/08/2024
Certification Date: 04/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

544 N TIMELESS DR
FAYETTEVILLE AR
72704-7638
US

IV. Provider business mailing address

544 N TIMELESS DR
FAYETTEVILLE AR
72704-7638
US

V. Phone/Fax

Practice location:
  • Phone: 479-883-6499
  • Fax: 479-765-1983
Mailing address:
  • Phone: 479-883-6499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code175M00000X
TaxonomyLay Midwife
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: