Provider Demographics
NPI:1083949879
Name:KILLOUGH, ASHLEY R (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:R
Last Name:KILLOUGH
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 UNIVERSITY BLVD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-2773
Mailing Address - Country:US
Mailing Address - Phone:508-517-9403
Mailing Address - Fax:
Practice Address - Street 1:500 UNIVERSITY BLVD
Practice Address - Street 2:SUITE 208
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-2773
Practice Address - Country:US
Practice Address - Phone:561-627-3130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-12
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5004480363LA2200X
FLARNP9370915363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health