Healthcare Provider Details

I. General information

NPI: 1699610287
Provider Name (Legal Business Name): ASHLEY WIGHTMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8556 WEEDSPORT SENNETT RD
WEEDSPORT NY
13166-9761
US

IV. Provider business mailing address

8556 WEEDSPORT SENNETT RD
WEEDSPORT NY
13166-9761
US

V. Phone/Fax

Practice location:
  • Phone: 315-730-5552
  • Fax:
Mailing address:
  • Phone: 315-730-5552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number035806
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: