Healthcare Provider Details

I. General information

NPI: 1023570983
Provider Name (Legal Business Name): ASHLEY BEAUDRY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2019
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 S LINCOLN RD
ESCANABA MI
49829-1292
US

IV. Provider business mailing address

7826 LAKE BLUFF 19.4 RD
GLADSTONE MI
49837-2443
US

V. Phone/Fax

Practice location:
  • Phone: 906-786-4628
  • Fax:
Mailing address:
  • Phone: 906-280-1616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601009496
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: