Provider Demographics
NPI:1174874382
Name:DIERKES, ASHLEY N (PA)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:N
Last Name:DIERKES
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:ASHLEY
Other - Middle Name:N
Other - Last Name:VAVREK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:5450 FRANTZ RD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-4134
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:285 E STATE ST
Practice Address - Street 2:SUITE 260
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-4354
Practice Address - Country:US
Practice Address - Phone:614-566-9035
Practice Address - Fax:614-566-9302
Is Sole Proprietor?:No
Enumeration Date:2012-09-27
Last Update Date:2017-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.003611363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant