Provider Demographics
NPI:1497903256
Name:VANZANT, ASHLEY A (PA)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:A
Last Name:VANZANT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:A
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:860 LYNN ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:MO
Mailing Address - Zip Code:65536-3810
Mailing Address - Country:US
Mailing Address - Phone:417-334-8337
Mailing Address - Fax:417-532-2067
Practice Address - Street 1:860 LYNN ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:MO
Practice Address - Zip Code:65536
Practice Address - Country:US
Practice Address - Phone:417-334-8337
Practice Address - Fax:417-532-2067
Is Sole Proprietor?:No
Enumeration Date:2008-09-05
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant