Provider Demographics
NPI:1487277208
Name:GATES, ASHLYN NICOLE (PA-C)
Entity type:Individual
Prefix:
First Name:ASHLYN
Middle Name:NICOLE
Last Name:GATES
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 1:2103 21ST ST SE APT 31
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-3570
Mailing Address - Country:US
Mailing Address - Phone:704-460-4840
Mailing Address - Fax:
Practice Address - Street 1:416 MCCULLOUGH DR STE 100
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-4386
Practice Address - Country:US
Practice Address - Phone:980-406-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-27
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant