Healthcare Provider Details

I. General information

NPI: 1659295350
Provider Name (Legal Business Name): ASHLEY WILKINSON
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

8711 US 31
INDIANAPOLIS IN
46227-6252
US

IV. Provider business mailing address

1402 E COUNTY LINE RD
INDIANAPOLIS IN
46227-0963
US

V. Phone/Fax

Practice location:
  • Phone: 317-887-7771
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10005376A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: