Healthcare Provider Details

I. General information

NPI: 1164964755
Provider Name (Legal Business Name): ASHLEY KUMP NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2016
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 HILLSIDE AVE
WILLISTON PARK NY
11596-2347
US

IV. Provider business mailing address

504 STILLBROOK CT
CANTON GA
30115-8919
US

V. Phone/Fax

Practice location:
  • Phone: 516-418-7724
  • Fax:
Mailing address:
  • Phone: 516-581-9457
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number408671
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number307832
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: