Healthcare Provider Details

I. General information

NPI: 1083037626
Provider Name (Legal Business Name): ASHLEY JOHNSON PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2014
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720A MEDICAL PARK DR STE 220
BILOXI MS
39532-2127
US

IV. Provider business mailing address

6300 E LAKE BLVD STE 301
VANCLEAVE MS
39565-6771
US

V. Phone/Fax

Practice location:
  • Phone: 228-230-2663
  • Fax: 228-206-6858
Mailing address:
  • Phone: 228-230-2663
  • Fax: 228-206-6858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number337806
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA00704
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: