Provider Demographics
NPI:1376889071
Name:RALSTON, ANASTASIA LEIGH
Entity Type:Individual
Prefix:DR
First Name:ANASTASIA
Middle Name:LEIGH
Last Name:RALSTON
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:ANASTASIA
Other - Middle Name:LEIGH
Other - Last Name:JORDAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1027 WASHINGTON AVE STE B
Mailing Address - Street 2:
Mailing Address - City:VINCENNES
Mailing Address - State:IN
Mailing Address - Zip Code:47591-2240
Mailing Address - Country:US
Mailing Address - Phone:618-554-0259
Mailing Address - Fax:
Practice Address - Street 1:1027 WASHINGTON AVE STE B
Practice Address - Street 2:
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591-2240
Practice Address - Country:US
Practice Address - Phone:812-494-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-27
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209010136363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily