Provider Demographics
NPI:1033362462
Name:FURGASON, ASHLEY CAROLYN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:CAROLYN
Last Name:FURGASON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:ASHLEY
Other - Middle Name:CAROLYN
Other - Last Name:NORDMEYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:10435 CLAYTON RD STE 120
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-2930
Mailing Address - Country:US
Mailing Address - Phone:314-442-4452
Mailing Address - Fax:866-216-3928
Practice Address - Street 1:10435 CLAYTON RD STE 120
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-2930
Practice Address - Country:US
Practice Address - Phone:314-442-4452
Practice Address - Fax:866-216-3928
Is Sole Proprietor?:No
Enumeration Date:2008-10-29
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085003334363A00000X
MO2010000950363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant