Provider Demographics
NPI:1194359562
Name:ASHMORE, NICHOL (APRN, FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:NICHOL
Middle Name:
Last Name:ASHMORE
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 W 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:COAL VALLEY
Mailing Address - State:IL
Mailing Address - Zip Code:61240-9358
Mailing Address - Country:US
Mailing Address - Phone:309-269-6797
Mailing Address - Fax:
Practice Address - Street 1:1106 4TH AVE
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-1231
Practice Address - Country:US
Practice Address - Phone:563-336-3000
Practice Address - Fax:563-327-2045
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-25
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209020843363LF0000X
IAA161611363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily