Healthcare Provider Details

I. General information

NPI: 1164238077
Provider Name (Legal Business Name): ASHLEY NICOLE CUMBERLEDGE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2024
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 DIVISION ST STE 304
SOUTH CHARLESTON WV
25309-1455
US

IV. Provider business mailing address

152 ROXALANA HILLS DR
DUNBAR WV
25064-1903
US

V. Phone/Fax

Practice location:
  • Phone: 304-767-7840
  • Fax: 304-767-7849
Mailing address:
  • Phone: 724-833-5067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2969
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00893800
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA066152
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: