Provider Demographics
NPI:1497402887
Name:RUSSELL, ASHLEY LYNN (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:LYNN
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 N 750 E
Mailing Address - Street 2:
Mailing Address - City:VERNAL
Mailing Address - State:UT
Mailing Address - Zip Code:84078-1809
Mailing Address - Country:US
Mailing Address - Phone:435-630-3259
Mailing Address - Fax:
Practice Address - Street 1:872 W HIGHWAY 40
Practice Address - Street 2:
Practice Address - City:VERNAL
Practice Address - State:UT
Practice Address - Zip Code:84078-2416
Practice Address - Country:US
Practice Address - Phone:435-781-8899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-04
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6238990-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
F02221129OtherAMERICAN ACADEMY OF NURSE PRACTITIONERS CERTIFICATION BOARD
UT6238990-4405OtherUTAH DEPARTMENT OF COMMERCE DOPL LICENSE