Healthcare Provider Details

I. General information

NPI: 1336630326
Provider Name (Legal Business Name): ASHTON ROBERTSON PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2018
Last Update Date: 07/09/2024
Certification Date: 07/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13100 N WESTERN AVE STE 303
OKLAHOMA CITY OK
73114-1432
US

IV. Provider business mailing address

3617 NW EXPRESSWAY
OKLAHOMA CITY OK
73112-4405
US

V. Phone/Fax

Practice location:
  • Phone: 800-781-1220
  • Fax: 888-678-8616
Mailing address:
  • Phone: 405-835-2775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA15620
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA207994
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.PA.61530948
License Number StateWA
# 4
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2918
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: