MEDICARE: JANELLE ASHLEY

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	363AM0700X	Medical Physician Assistant
2	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1538936182
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANELLE ASHLEY

Provider Business Mailing Address
First Line	:	715 N GRAHAM ST STE 202
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28202-2047
Country	:	US
Telephone Number	:	704-724-7331
Fax Number	:

Provider Business Practice Location Address
First Line	:	7731 LITTLE AVE STE B
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28226-8290
Country	:	US
Telephone Number	:	704-724-7331
Fax Number	:

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

Provider Enumeration Date	:	12/05/2023
Last Update Date	:	12/05/2023

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Directions to “ JANELLE ASHLEY ” Practice Location

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