Provider Demographics
NPI:1629328042
Name:BEARB, ASHLEY LANE (NP)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:LANE
Last Name:BEARB
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:5665 NEW NORTHSIDE DR NW
Mailing Address - Street 2:SUITE 320
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-5831
Mailing Address - Country:US
Mailing Address - Phone:770-874-5439
Mailing Address - Fax:770-874-5483
Practice Address - Street 1:1214 COOLIDGE BLVD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2621
Practice Address - Country:US
Practice Address - Phone:337-289-7529
Practice Address - Fax:337-289-7190
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-13
Last Update Date:2012-09-13
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Provider Licenses
StateLicense IDTaxonomies
LARN115366363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner