Provider Demographics
NPI:1235301144
Name:STEVENSON, ASHLEY A (PA-C)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:A
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:N
Other - Last Name:ASBURY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2050 MEADOWVIEW PKWY
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660
Mailing Address - Country:US
Mailing Address - Phone:423-230-5000
Mailing Address - Fax:423-230-5097
Practice Address - Street 1:1 MEDICAL PARK BLVD
Practice Address - Street 2:SUITE 458W
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620
Practice Address - Country:US
Practice Address - Phone:423-230-6900
Practice Address - Fax:423-230-5097
Is Sole Proprietor?:No
Enumeration Date:2008-03-31
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
TN1606363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I971975Medicare PIN