Healthcare Provider Details

I. General information

NPI: 1366203424
Provider Name (Legal Business Name): ASHTON P WINCE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2024
Last Update Date: 08/22/2025
Certification Date: 08/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6210 S BROADWAY AVE
TYLER TX
75703-4413
US

IV. Provider business mailing address

6210 S BROADWAY AVE
TYLER TX
75703-4413
US

V. Phone/Fax

Practice location:
  • Phone: 903-579-2700
  • Fax:
Mailing address:
  • Phone: 903-579-2700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA19287
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: