Provider Demographics
NPI:1619425709
Name:WOOTEN, ASHLEI L (FNP-C)
Entity Type:Individual
Prefix:
First Name:ASHLEI
Middle Name:L
Last Name:WOOTEN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:ASHLEI
Other - Middle Name:L
Other - Last Name:GRAHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:3110 NOGALITOS STE 105
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78225-2337
Mailing Address - Country:US
Mailing Address - Phone:210-533-0257
Mailing Address - Fax:210-534-0890
Practice Address - Street 1:3110 NOGALITOS STE 105
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78225-2337
Practice Address - Country:US
Practice Address - Phone:210-533-0257
Practice Address - Fax:210-534-0890
Is Sole Proprietor?:No
Enumeration Date:2016-09-17
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP131978363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX374122501Medicaid