Healthcare Provider Details

I. General information

NPI: 1417375049
Provider Name (Legal Business Name): ASHLEY MO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2014
Last Update Date: 08/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2350 W HORIZON RIDGE PKWY
HENDERSON NV
89052
US

IV. Provider business mailing address

2350 W HORIZON RIDGE PKWY
HENDERSON NV
89052-5075
US

V. Phone/Fax

Practice location:
  • Phone: 702-564-8556
  • Fax: 702-564-4485
Mailing address:
  • Phone: 702-564-8556
  • Fax: 702-564-4485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number17225
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: