Provider Demographics
NPI:1235411182
Name:DONATO, ASHLEY REBECCA (LAC)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:REBECCA
Last Name:DONATO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:REBECCA
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:782 WEATHERLY DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-8941
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:782 WEATHERLY DR
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043
Practice Address - Country:UM
Practice Address - Phone:931-645-3552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-16
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA200030208VP0000X
NY005809208VP0000X
FLAP3599171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine