Provider Demographics
NPI:1801144423
Name:SMITH, ASHLEY ELISE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:ELISE
Last Name:SMITH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:ASHLEY
Other - Middle Name:ELISE
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1945 GARRY OAKS AVE UNIT B
Mailing Address - Street 2:
Mailing Address - City:DUPONT
Mailing Address - State:WA
Mailing Address - Zip Code:98327-6705
Mailing Address - Country:US
Mailing Address - Phone:919-757-7206
Mailing Address - Fax:
Practice Address - Street 1:1945 GARRY OAKS AVE UNIT B
Practice Address - Street 2:
Practice Address - City:DUPONT
Practice Address - State:WA
Practice Address - Zip Code:98327-6705
Practice Address - Country:US
Practice Address - Phone:919-757-7206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60294898363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant