Healthcare Provider Details

I. General information

NPI: 1639725203
Provider Name (Legal Business Name): ASHLEY ACAJABON FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2019
Last Update Date: 03/18/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 MITCHELL AVE
BATESVILLE IN
47006-8890
US

IV. Provider business mailing address

321 MITCHELL AVE
BATESVILLE IN
47006-8890
US

V. Phone/Fax

Practice location:
  • Phone: 812-934-6624
  • Fax:
Mailing address:
  • Phone: 812-934-6624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1143336
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number399333
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28215508A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3014343
License Number StateKY
# 5
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71009456A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: