Healthcare Provider Details

I. General information

NPI: 1932565454
Provider Name (Legal Business Name): ERIN ELANE ASHLEY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ERIN ELANE CAMPBELL PA-C

II. Dates (important events)

Enumeration Date: 01/13/2016
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1409 E KENOSHA ST
BROKEN ARROW OK
74012-2012
US

IV. Provider business mailing address

1409 E KENOSHA ST
BROKEN ARROW OK
74012-2012
US

V. Phone/Fax

Practice location:
  • Phone: 918-262-4515
  • Fax: 918-883-7221
Mailing address:
  • Phone: 918-520-4742
  • Fax: 949-883-7221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2621
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: