Healthcare Provider Details

I. General information

NPI: 1154825651
Provider Name (Legal Business Name): ASHLEY OVERALL CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2018
Last Update Date: 07/27/2022
Certification Date: 03/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 S WOODLANDS VILLAGE BLVD STE 12
FLAGSTAFF AZ
86001-6373
US

IV. Provider business mailing address

719 SAN MATEO BLVD NE
ALBUQUERQUE NM
87108-1434
US

V. Phone/Fax

Practice location:
  • Phone: 928-774-2951
  • Fax:
Mailing address:
  • Phone: 505-485-0464
  • Fax: 505-266-1017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.022400
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0994337-NP
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPRN.CNP.022400
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number226709
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: