Healthcare Provider Details

I. General information

NPI: 1285256065
Provider Name (Legal Business Name): ASHLEY SOUTHERN NMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2020
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1532 W CAYUSE CREEK DR
MERIDIAN ID
83646-4795
US

IV. Provider business mailing address

1532 W CAYUSE CREEK DR
MERIDIAN ID
83646-4795
US

V. Phone/Fax

Practice location:
  • Phone: 208-690-2040
  • Fax:
Mailing address:
  • Phone: 480-270-8318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number20-1857
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: