Healthcare Provider Details

I. General information

NPI: 1356840201
Provider Name (Legal Business Name): ASHLEY DAWN MUMBY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2018
Last Update Date: 08/11/2023
Certification Date: 08/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12230 LIONESS WAY
PARKER CO
80134-5603
US

IV. Provider business mailing address

9250 E COSTILLA AVE STE 540
GREENWOOD VILLAGE CO
80112-3648
US

V. Phone/Fax

Practice location:
  • Phone: 720-644-9355
  • Fax:
Mailing address:
  • Phone: 720-644-9355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA0005269
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: