Provider Demographics
NPI:1205370814
Name:HOLSTON, ASHLEY GABRIELLE (NP)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:GABRIELLE
Last Name:HOLSTON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7014 WATCHMAN CIR
Mailing Address - Street 2:APT E
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36116-6728
Mailing Address - Country:US
Mailing Address - Phone:334-224-0760
Mailing Address - Fax:
Practice Address - Street 1:2761 AGNES LN
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-2029
Practice Address - Country:US
Practice Address - Phone:843-492-2710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-15
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5950363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily