Provider Demographics
NPI:1235612086
Name:FORT, ASHLIE NICHOLE
Entity Type:Individual
Prefix:
First Name:ASHLIE
Middle Name:NICHOLE
Last Name:FORT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 S TRAVIS ST APT 208
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75090-9023
Mailing Address - Country:US
Mailing Address - Phone:903-357-8288
Mailing Address - Fax:
Practice Address - Street 1:2700 S TRAVIS ST APT 208
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-9023
Practice Address - Country:US
Practice Address - Phone:903-357-8288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-07
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant