Provider Demographics
NPI:1568834554
Name:FREEMAN, ASHLEY NICOLE (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:NICOLE
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:NICOLE
Other - Last Name:MCFARLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:10012 KENNERLY RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2197
Mailing Address - Country:US
Mailing Address - Phone:314-842-0602
Mailing Address - Fax:314-842-4372
Practice Address - Street 1:10012 KENNERLY RD
Practice Address - Street 2:SUITE 300
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2197
Practice Address - Country:US
Practice Address - Phone:314-842-0602
Practice Address - Fax:314-842-4372
Is Sole Proprietor?:No
Enumeration Date:2015-10-29
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015032924363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOMA3163036Medicare PIN