MEDICARE: ASHLEY AYERS STUDENT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1477123545
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY AYERS STUDENT

Provider Business Mailing Address
First Line	:	3637 GENE FIELD RD APT G31
Second Line	:
City	:	SAINT JOSEPH
State	:	MO
Zip	:	64506-4832
Country	:	US
Telephone Number	:	573-470-6358
Fax Number	:

Provider Business Practice Location Address
First Line	:	3637 GENE FIELD RD APT G31
Second Line	:
City	:	SAINT JOSEPH
State	:	MO
Zip	:	64506-4832
Country	:	US
Telephone Number	:	573-470-6358
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2021
Last Update Date	:	06/30/2021

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Directions to “ ASHLEY AYERS STUDENT” Practice Location

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