Provider Demographics
NPI:1134653314
Name:HEFNER, ASHLEY E (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:E
Last Name:HEFNER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:ASHLEY
Other - Middle Name:E
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA C
Mailing Address - Street 1:12700 PARK CENTRAL DRIVE
Mailing Address - Street 2:SUITE 900
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75251
Mailing Address - Country:US
Mailing Address - Phone:214-860-6034
Mailing Address - Fax:972-852-9075
Practice Address - Street 1:10506 MONTGOMERY RD.
Practice Address - Street 2:SUITE 209
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242
Practice Address - Country:US
Practice Address - Phone:513-865-9040
Practice Address - Fax:513-865-9046
Is Sole Proprietor?:No
Enumeration Date:2017-04-14
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.004995RX363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1043274418Medicaid