Provider Demographics
NPI:1043762719
Name:WILTCHER, ASHLEY MICHELLE (AGPCNP)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:MICHELLE
Last Name:WILTCHER
Suffix:
Gender:F
Credentials:AGPCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:ALBERMARLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-3350
Mailing Address - Country:US
Mailing Address - Phone:704-983-4216
Mailing Address - Fax:704-983-6662
Practice Address - Street 1:960 N 1ST ST
Practice Address - Street 2:
Practice Address - City:ALBERMARLE
Practice Address - State:NC
Practice Address - Zip Code:28801-3350
Practice Address - Country:US
Practice Address - Phone:704-983-4216
Practice Address - Fax:704-983-6662
Is Sole Proprietor?:No
Enumeration Date:2016-10-28
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP09060363LF0000X, 363LG0600X, 364SG0600X
NC5015372363LA2200X, 363LG0600X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No364SG0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2432761Medicaid
LA2432761Medicaid