Provider Demographics
NPI:1073083903
Name:GENTRY, ASHLEY BRIANA-MARIE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:ASHLEY
Middle Name:BRIANA-MARIE
Last Name:GENTRY
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 1:112 JONES RD
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75603-5842
Mailing Address - Country:US
Mailing Address - Phone:903-235-9787
Mailing Address - Fax:
Practice Address - Street 1:707 HOLLYBROOK DR # 200
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-2410
Practice Address - Country:US
Practice Address - Phone:903-235-9787
Practice Address - Fax:903-291-6155
Is Sole Proprietor?:No
Enumeration Date:2018-12-04
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA12464363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant