Healthcare Provider Details

I. General information

NPI: 1629542659
Provider Name (Legal Business Name): ASHLYN CAMPBELL MCGLOTHLIN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASHLYN NICOLE TONI CAMPBELL PA

II. Dates (important events)

Enumeration Date: 01/12/2019
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1906 BELLEVIEW AVE SE
ROANOKE VA
24014-1838
US

IV. Provider business mailing address

213 S JEFFERSON ST STE 1006
ROANOKE VA
24011-1713
US

V. Phone/Fax

Practice location:
  • Phone: 540-981-7000
  • Fax: 540-853-0931
Mailing address:
  • Phone: 540-224-5516
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110007054
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: