Provider Demographics
NPI:1518290956
Name:SANDERS, ASHLEY E (PA)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:E
Last Name:SANDERS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 PINSON RD
Mailing Address - Street 2:
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-9766
Mailing Address - Country:US
Mailing Address - Phone:972-564-9380
Mailing Address - Fax:972-564-9287
Practice Address - Street 1:410 PINSON RD
Practice Address - Street 2:
Practice Address - City:FORNEY
Practice Address - State:TX
Practice Address - Zip Code:75126-9766
Practice Address - Country:US
Practice Address - Phone:972-564-9380
Practice Address - Fax:972-564-9287
Is Sole Proprietor?:No
Enumeration Date:2009-09-17
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03493363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L20293Medicare PIN
TX8L20294Medicare PIN
TX8L20295Medicare PIN