Provider Demographics
NPI:1053819912
Name:JOHNSON, ASHLEY P B (CD, BEC)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:P B
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CD, BEC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1772 FAIRFAX ST
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23805-1649
Mailing Address - Country:US
Mailing Address - Phone:804-647-8692
Mailing Address - Fax:
Practice Address - Street 1:1772 FAIRFAX ST
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23805-1649
Practice Address - Country:US
Practice Address - Phone:804-647-8692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-25
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoula
No174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Multi-Specialty