Provider Demographics
NPI:1497214118
Name:NELSON, ASHLEY N
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:N
Last Name:NELSON
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 1:2632 BRECKENRIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-6669
Mailing Address - Country:US
Mailing Address - Phone:636-466-6539
Mailing Address - Fax:877-500-6864
Practice Address - Street 1:2632 BRECKENRIDGE CIR
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-6669
Practice Address - Country:US
Practice Address - Phone:636-466-6539
Practice Address - Fax:877-500-6864
Is Sole Proprietor?:No
Enumeration Date:2019-03-13
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator