Healthcare Provider Details

I. General information

NPI: 1992336333
Provider Name (Legal Business Name): ASHLEY AUTUMN PEASE CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2020
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11121 DIAMOND STREAM DR
SPANISH SPRINGS NV
89441-5239
US

IV. Provider business mailing address

7780 GUENIVERE WAY
CITRUS HEIGHTS CA
95610-6763
US

V. Phone/Fax

Practice location:
  • Phone: 559-380-9956
  • Fax:
Mailing address:
  • Phone: 559-380-9956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number862423
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95024490
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP61002883
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: