Provider Demographics
NPI:1558397844
Name:QUADE, ASHLEY M (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:M
Last Name:QUADE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:ASHLEY
Other - Middle Name:M
Other - Last Name:PANCAKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:679 E COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-1049
Mailing Address - Country:US
Mailing Address - Phone:317-807-1262
Mailing Address - Fax:317-859-4268
Practice Address - Street 1:8240 NAAB RD
Practice Address - Street 2:SUITE 200
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-5927
Practice Address - Country:US
Practice Address - Phone:317-876-2330
Practice Address - Fax:317-876-2320
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10000871A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP00701337OtherMEDICARE RAILROAD
IN1487680518OtherGROUP NPI
IN000000485659OtherANTHEM PIN NUMBER
IN1487680518OtherGROUP NPI
IN000000485659OtherANTHEM PIN NUMBER
IN318870TMedicare PIN