Healthcare Provider Details

I. General information

NPI: 1912784554
Provider Name (Legal Business Name): ASHLEY LEE MCCONNAHA CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2023
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 S LUDLOW ST
DAYTON OH
45402-2610
US

IV. Provider business mailing address

3170 KETTERING BLVD # B2
MORAINE OH
45439-1924
US

V. Phone/Fax

Practice location:
  • Phone: 937-734-9810
  • Fax: 937-734-9830
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1125470
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: