Provider Demographics
NPI:1639867211
Name:WILLINGHAM, ASHLEY M
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:M
Last Name:WILLINGHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:
Other - Last Name:DOMZALSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4715 WHITESBURG DR SE
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35802-1649
Mailing Address - Country:US
Mailing Address - Phone:256-881-5151
Mailing Address - Fax:256-880-3939
Practice Address - Street 1:4715 WHITESBURG DR SE
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35802-1649
Practice Address - Country:US
Practice Address - Phone:256-881-5151
Practice Address - Fax:256-880-3939
Is Sole Proprietor?:No
Enumeration Date:2023-05-01
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-166173363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily