Healthcare Provider Details

I. General information

NPI: 1174430599
Provider Name (Legal Business Name): ASHLEY ALEXIS SHASTID
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6815 WHITEMAN RD SW
LONGBRANCH WA
98351-8252
US

IV. Provider business mailing address

6815 WHITEMAN RD SW
LONGBRANCH WA
98351-8252
US

V. Phone/Fax

Practice location:
  • Phone: 360-620-3056
  • Fax:
Mailing address:
  • Phone: 360-620-3056
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP.AP.70167358-NP
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: