Provider Demographics
NPI: | 1003311291 |
---|---|
Name: | TWYMAN, ASHLEY MARIE (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | ASHLEY |
Middle Name: | MARIE |
Last Name: | TWYMAN |
Suffix: | |
Gender: | F |
Credentials: | MD |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | PO BOX 845347 |
Mailing Address - Street 2: | |
Mailing Address - City: | DALLAS |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 75284-7208 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 214-645-3597 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 2500 NE NEFF RD |
Practice Address - Street 2: | |
Practice Address - City: | BEND |
Practice Address - State: | OR |
Practice Address - Zip Code: | 97701-6015 |
Practice Address - Country: | US |
Practice Address - Phone: | 541-706-6892 |
Practice Address - Fax: | 541-706-6813 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2018-03-28 |
Last Update Date: | 2024-03-04 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
KY | 55134 | 207R00000X |
390200000X | ||
TX | U4956 | 208M00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 208M00000X | Allopathic & Osteopathic Physicians | Hospitalist | |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | |
No | 390200000X | Student, Health Care | Student in an Organized Health Care Education/Training Program |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
KY | 7100608810 | Medicaid |