Provider Demographics
NPI:1497787691
Name:THOMAS, ASHLEY SIMPSON (FNP)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:SIMPSON
Last Name:THOMAS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 MORRIS CIR
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:LA
Mailing Address - Zip Code:71040-2100
Mailing Address - Country:US
Mailing Address - Phone:318-927-1110
Mailing Address - Fax:318-927-1116
Practice Address - Street 1:104 MORRIS CIR
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:LA
Practice Address - Zip Code:71040-2100
Practice Address - Country:US
Practice Address - Phone:318-927-1110
Practice Address - Fax:318-927-1116
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN088576 AP04826363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1721379Medicaid
LA1721379Medicaid
LA4H732B579Medicare PIN