Healthcare Provider Details

I. General information

NPI: 1164281481
Provider Name (Legal Business Name): ASHLEY SO FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2024
Last Update Date: 02/19/2026
Certification Date: 02/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25700 N 21ST AVE
PHOENIX AZ
85085-8680
US

IV. Provider business mailing address

40233 N 2ND DR
PHOENIX AZ
85086-0801
US

V. Phone/Fax

Practice location:
  • Phone: 623-445-5810
  • Fax:
Mailing address:
  • Phone: 480-388-2237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number335800
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: