Provider Demographics
NPI:1548741085
Name:HENDRICKS, ASHLEY (CNP)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:HENDRICKS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:
Other - Last Name:ROESE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:166 SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:CIRCLEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43113-2210
Mailing Address - Country:US
Mailing Address - Phone:740-420-3151
Mailing Address - Fax:
Practice Address - Street 1:166 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:CIRCLEVILLE
Practice Address - State:OH
Practice Address - Zip Code:43113-2210
Practice Address - Country:US
Practice Address - Phone:740-420-3151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-23
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.385054163WE0003X
OHAPRN.CNP.023953363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WE0003XNursing Service ProvidersRegistered NurseEmergency