Provider Demographics
NPI:1093218547
Name:ANDERSON, ASHLEY (PNP)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:
Other - Last Name:SOUTHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1300
Mailing Address - Street 2:
Mailing Address - City:WINNSBORO
Mailing Address - State:LA
Mailing Address - Zip Code:71295-1300
Mailing Address - Country:US
Mailing Address - Phone:318-412-5265
Mailing Address - Fax:318-435-3842
Practice Address - Street 1:2104 LOOP RD STE C
Practice Address - Street 2:
Practice Address - City:WINNSBORO
Practice Address - State:LA
Practice Address - Zip Code:71295-3341
Practice Address - Country:US
Practice Address - Phone:318-435-4571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-12
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA12312341363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics