Healthcare Provider Details

I. General information

NPI: 1235406448
Provider Name (Legal Business Name): ASHLEY BERNIARD PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASHLEY LYNNE CAPONE P.A.

II. Dates (important events)

Enumeration Date: 11/17/2011
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 KINGWOOD MEDICAL DRIVE SUITE 200
KINGWOOD TX
77339
US

IV. Provider business mailing address

22710 PROFESSIONAL DR SUITE 102
KINGWOOD TX
77339
US

V. Phone/Fax

Practice location:
  • Phone: 281-359-2080
  • Fax: 281-359-2421
Mailing address:
  • Phone: 281-685-2709
  • Fax: 281-719-5927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA07461
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: