Provider Demographics
NPI:1033691191
Name:BRADEN, ASHTYNN RAE (PA-C)
Entity Type:Individual
Prefix:
First Name:ASHTYNN
Middle Name:RAE
Last Name:BRADEN
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 1:815 ANN AVE APT 3D
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63104-4103
Mailing Address - Country:US
Mailing Address - Phone:618-927-8355
Mailing Address - Fax:
Practice Address - Street 1:815 ANN AVE APT 3D
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63104-4103
Practice Address - Country:US
Practice Address - Phone:618-927-8355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-05
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022000534363A00000X
IL085006778363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant