Provider Demographics
NPI:1083195150
Name:HARRELL, ASHLEY JADE (LVN)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:JADE
Last Name:HARRELL
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 FRANKFORD AVE APT 731A
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79416-5066
Mailing Address - Country:US
Mailing Address - Phone:325-213-9612
Mailing Address - Fax:
Practice Address - Street 1:1002 FRANKFORD AVE APT 731A
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79416-5066
Practice Address - Country:US
Practice Address - Phone:325-213-9612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX332698164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse