Healthcare Provider Details

I. General information

NPI: 1669936639
Provider Name (Legal Business Name): ASHLYNN DUERKSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASHLYNN HAMM

II. Dates (important events)

Enumeration Date: 01/24/2019
Last Update Date: 07/05/2022
Certification Date: 07/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1133 COLLEGE AVE STE E230
MANHATTAN KS
66502-2818
US

IV. Provider business mailing address

1133 COLLEGE AVE STE E230
MANHATTAN KS
66502-2818
US

V. Phone/Fax

Practice location:
  • Phone: 785-587-1825
  • Fax: 785-587-1828
Mailing address:
  • Phone: 785-587-1825
  • Fax: 785-587-1828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateKS
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11-06989
License Number StateKS

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: