Provider Demographics
NPI:1659154318
Name:ROBINSON, ASHLEY
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SASSYSUCCESS70092@GMAIL.COM
Mailing Address - Street 2:1601 MAGNOLIA ST
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70460
Mailing Address - Country:US
Mailing Address - Phone:985-774-3764
Mailing Address - Fax:
Practice Address - Street 1:1601 MAGNOLIA ST
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70460-8874
Practice Address - Country:US
Practice Address - Phone:985-774-3764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA009673948172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver