Provider Demographics
NPI:1376835215
Name:CRISP, ASHLEY LAUREN (MD)
Entity Type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:LAUREN
Last Name:CRISP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3045 S NATIONAL AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-4268
Mailing Address - Country:US
Mailing Address - Phone:417-888-6790
Mailing Address - Fax:
Practice Address - Street 1:3045 S NATIONAL AVE STE 110
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-4268
Practice Address - Country:US
Practice Address - Phone:417-888-6790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN51941207Q00000X
VA0101256105207Q00000X
MO2016022195207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine