Healthcare Provider Details

I. General information

NPI: 1568832996
Provider Name (Legal Business Name): ASHLEY MUELLER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2015
Last Update Date: 11/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5430 MACCORKLE AVE SE
CHARLESTON WV
25304-2224
US

IV. Provider business mailing address

5430 MACCORKLE AVE SE
CHARLESTON WV
25304-2224
US

V. Phone/Fax

Practice location:
  • Phone: 304-925-3627
  • Fax:
Mailing address:
  • Phone: 304-925-3627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2742
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: