MEDICARE: ASHLEY ANDERSON PA-C

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	363A00000X	Physician Assistant	PA03517	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	8N0042	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1659366623
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY ANDERSON PA-C

Provider Business Mailing Address
First Line	:	17350 ST LUKES WAY STE 400
Second Line	:
City	:	THE WOODLANDS
State	:	TX
Zip	:	77384-4167
Country	:	US
Telephone Number	:	281-444-3278
Fax Number	:	832-249-3850

Provider Business Practice Location Address
First Line	:	17350 ST. LUKES WAY
Second Line	:	STE 400
City	:	THE WOODLANDS
State	:	TX
Zip	:	77384-4167
Country	:	US
Telephone Number	:	281-444-3278
Fax Number	:	832-249-3861

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

Provider Enumeration Date	:	09/15/2005
Last Update Date	:	01/17/2023

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Directions to “ ASHLEY ANDERSON PA-C” Practice Location

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