Healthcare Provider Details

I. General information

NPI: 1881417285
Provider Name (Legal Business Name): ASHLEY MCGOVERN PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2024
Last Update Date: 03/29/2026
Certification Date: 03/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7192 KALANIANAOLE HWY STE G225
HONOLULU HI
96825-1846
US

IV. Provider business mailing address

13 N WASHINGTON ST # 225
YPSILANTI MI
48197-2617
US

V. Phone/Fax

Practice location:
  • Phone: 313-355-2617
  • Fax: 866-309-9530
Mailing address:
  • Phone: 313-355-2196
  • Fax: 866-309-9530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4704350239
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: