Provider Demographics
NPI:1609472679
Name:THOMAS, ASHLEY JENE' E (CRNP)
Entity Type:Individual
Prefix:MISS
First Name:ASHLEY
Middle Name:JENE' E
Last Name:THOMAS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MISS
Other - First Name:ASHLEY
Other - Middle Name:JENE' E
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNP
Mailing Address - Street 1:8500 ALLENSWOOD RD
Mailing Address - Street 2:
Mailing Address - City:RANDALLSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21133-4604
Mailing Address - Country:US
Mailing Address - Phone:443-796-8515
Mailing Address - Fax:
Practice Address - Street 1:8500 ALLENSWOOD RD
Practice Address - Street 2:
Practice Address - City:RANDALLSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21133-4604
Practice Address - Country:US
Practice Address - Phone:443-796-8515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-07
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR217978207Q00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine