Healthcare Provider Details

I. General information

NPI: 1942728183
Provider Name (Legal Business Name): ASHLEY JOHNSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2017
Last Update Date: 05/22/2024
Certification Date: 05/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 S PLUM ST
VERMILLION SD
57069-3306
US

IV. Provider business mailing address

1104 W 8TH ST
YANKTON SD
57078-3306
US

V. Phone/Fax

Practice location:
  • Phone: 605-624-8643
  • Fax:
Mailing address:
  • Phone: 605-665-7841
  • Fax: 605-665-8337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1106
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: