MEDICARE: ASHLEY NICOLE DENMARK DO

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	207Q00000X	Family Medicine Physician	LL37642	SC
2	207Q00000X	Family Medicine Physician	2018025922	MO

General Provider Information

NPI Number	:	1912388943
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY NICOLE DENMARK DO

Provider Business Mailing Address
First Line	:	3009 N BALLAS RD STE 227A
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63131-2308
Country	:	US
Telephone Number	:	314-996-7800
Fax Number	:

Provider Business Practice Location Address
First Line	:	3009 N BALLAS RD STE 227A
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63131-2308
Country	:	US
Telephone Number	:	314-996-7800
Fax Number	:

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

Provider Enumeration Date	:	06/16/2015
Last Update Date	:	03/03/2021

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