Provider Demographics
NPI:1598247967
Name:BRAGG, ASHLEIGH MICHELLE (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEIGH
Middle Name:MICHELLE
Last Name:BRAGG
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2315 TECHNOLOGY DR STE 129
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-7371
Mailing Address - Country:US
Mailing Address - Phone:636-265-0377
Mailing Address - Fax:
Practice Address - Street 1:2315 TECHNOLOGY DR STE 129
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-7371
Practice Address - Country:US
Practice Address - Phone:636-265-0377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-03
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018026939363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily