Provider Demographics
NPI:1023662806
Name:LOUGHEED, ASHLEY S (PA-C)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:S
Last Name:LOUGHEED
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1935 N LOGAN ST APT 713
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80203-4414
Mailing Address - Country:US
Mailing Address - Phone:602-570-5406
Mailing Address - Fax:
Practice Address - Street 1:36 STEELE ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-5729
Practice Address - Country:US
Practice Address - Phone:720-634-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-30
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0005121363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant