Provider Demographics
NPI:1619100278
Name:CARROLL, ASHLEY MARIE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:MARIE
Last Name:CARROLL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:MARIE
Other - Last Name:PEREYRA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2790 CLAY EDWARDS DR STE 625
Mailing Address - Street 2:
Mailing Address - City:NORTH KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64116-3278
Mailing Address - Country:US
Mailing Address - Phone:816-455-3990
Mailing Address - Fax:816-455-5351
Practice Address - Street 1:2790 CLAY EDWARDS DR STE 625
Practice Address - Street 2:
Practice Address - City:NORTH KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-3278
Practice Address - Country:US
Practice Address - Phone:816-455-3990
Practice Address - Fax:816-455-5351
Is Sole Proprietor?:No
Enumeration Date:2009-08-31
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20491363A00000X
MO2021023485363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant