Provider Demographics
NPI:1033362462
Name:REEDY, ASHLEY CAROLYN (PA-C)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:CAROLYN
Last Name:REEDY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:ASHLEY
Other - Middle Name:CAROLYN
Other - Last Name:FURGASON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:14825 N OUTER FORTY RD STE 310
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017
Mailing Address - Country:US
Mailing Address - Phone:314-442-4452
Mailing Address - Fax:866-216-3928
Practice Address - Street 1:14825 N OUTER FORTY RD STE 310
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017
Practice Address - Country:US
Practice Address - Phone:314-442-4452
Practice Address - Fax:866-216-3928
Is Sole Proprietor?:No
Enumeration Date:2008-10-29
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085003334363A00000X
MO2010000950363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant