Provider Demographics
NPI:1669016903
Name:RISDON, ASHLEY MORAN (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:MORAN
Last Name:RISDON
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 W 58TH ST FL 12
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-2515
Mailing Address - Country:US
Mailing Address - Phone:917-660-4179
Mailing Address - Fax:
Practice Address - Street 1:4 W 58TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-2515
Practice Address - Country:US
Practice Address - Phone:212-249-0949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-30
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11004889363LF0000X
CT8617363LF0000X
NY347550363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily