Healthcare Provider Details

I. General information

NPI: 1932890340
Provider Name (Legal Business Name): ASHLEY THORNHILL MCCULLOUGH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2023
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 JOHNSTOWN CENTER DR
JOHNSTOWN CO
80534-9030
US

IV. Provider business mailing address

222 JOHNSTOWN CENTER DR
JOHNSTOWN CO
80534-9030
US

V. Phone/Fax

Practice location:
  • Phone: 970-587-4974
  • Fax:
Mailing address:
  • Phone: 970-587-4974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDR.0077267
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: