Provider Demographics
NPI:1407469125
Name:NAKWAASAH, ASHLEY JOHNSON (AGNP-C)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:JOHNSON
Last Name:NAKWAASAH
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:BROOKE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, BSN
Mailing Address - Street 1:14650 LANDMARK BLVD APT 1508
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254-6932
Mailing Address - Country:US
Mailing Address - Phone:804-363-2263
Mailing Address - Fax:
Practice Address - Street 1:14650 LANDMARK BLVD APT 1508
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75254-6932
Practice Address - Country:US
Practice Address - Phone:804-363-2263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAG08200124363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty