Healthcare Provider Details

I. General information

NPI: 1053778209
Provider Name (Legal Business Name): ASHLEY BLAND ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2016
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2709 W BRIGGS AVE STE 1
FAIRFIELD IA
52556-2649
US

IV. Provider business mailing address

2709 W BRIGGS AVE STE 1
FAIRFIELD IA
52556-2649
US

V. Phone/Fax

Practice location:
  • Phone: 641-209-6097
  • Fax:
Mailing address:
  • Phone: 641-209-6097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA110162
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: