Provider Demographics
NPI:1366248445
Name:GULLY, ASHTON MARY (PA-C)
Entity type:Individual
Prefix:
First Name:ASHTON
Middle Name:MARY
Last Name:GULLY
Suffix:
Gender:
Credentials:PA-C
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Mailing Address - Street 1:6301 HARRIS PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-4265
Mailing Address - Country:US
Mailing Address - Phone:817-433-3450
Mailing Address - Fax:
Practice Address - Street 1:6301 HARRIS PKWY STE 200
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-4265
Practice Address - Country:US
Practice Address - Phone:817-433-3450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-20
Last Update Date:2025-02-20
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical