Healthcare Provider Details

I. General information

NPI: 1417531930
Provider Name (Legal Business Name): ASHLEY D VERSLUYS AGNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2021
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 MEMORIAL DR
BELLEVILLE IL
62226-5360
US

IV. Provider business mailing address

PO BOX 959203
SAINT LOUIS MO
63195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 618-257-6220
  • Fax: 618-257-6679
Mailing address:
  • Phone: 618-257-6220
  • Fax: 618-257-6679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209023360
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number209023360
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: