Provider Demographics
NPI:1275048894
Name:KELLEY, ASHTON HAYNES (APRN)
Entity Type:Individual
Prefix:MRS
First Name:ASHTON
Middle Name:HAYNES
Last Name:KELLEY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 S KEENE ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-6603
Mailing Address - Country:US
Mailing Address - Phone:573-777-4700
Mailing Address - Fax:844-366-3221
Practice Address - Street 1:100 S KEENE ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-6603
Practice Address - Country:US
Practice Address - Phone:573-777-4700
Practice Address - Fax:844-366-3221
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-05
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5010090363L00000X
ARA005241363LF0000X
MO2021039843363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty