Provider Demographics
NPI:1477312460
Name:BURCH, ASHLEY ALEXIS
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:ALEXIS
Last Name:BURCH
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 1:176 WESCOT DR NW
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-5553
Mailing Address - Country:US
Mailing Address - Phone:318-243-9798
Mailing Address - Fax:
Practice Address - Street 1:176 WESCOT DR NW
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-5553
Practice Address - Country:US
Practice Address - Phone:318-243-9798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-13
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN159912163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse