Provider Demographics
NPI:1609411784
Name:TITCHENAL, ASHLEY MARIE (AGNP)
Entity Type:Individual
Prefix:MS
First Name:ASHLEY
Middle Name:MARIE
Last Name:TITCHENAL
Suffix:
Gender:F
Credentials:AGNP
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Mailing Address - Street 1:PO BOX 60352
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63160-0352
Mailing Address - Country:US
Mailing Address - Phone:314-362-7388
Mailing Address - Fax:833-301-0853
Practice Address - Street 1:4921 PARKVIEW PL
Practice Address - Street 2:DIV SURG PLASTICS, STE 6G
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1032
Practice Address - Country:US
Practice Address - Phone:314-362-7388
Practice Address - Fax:833-301-0853
Is Sole Proprietor?:No
Enumeration Date:2019-11-12
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2019040757363LP2300X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO420080861Medicaid