Provider Demographics
NPI:1669858429
Name:OLDHAM, ASHLEY M (FNP)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:M
Last Name:OLDHAM
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 S 2ND STREET
Mailing Address - Street 2:
Mailing Address - City:ELLINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63638-0157
Mailing Address - Country:US
Mailing Address - Phone:573-663-2313
Mailing Address - Fax:573-663-2441
Practice Address - Street 1:220 EAST BROAD STREET
Practice Address - Street 2:
Practice Address - City:NAYLOR
Practice Address - State:MO
Practice Address - Zip Code:63953-0038
Practice Address - Country:US
Practice Address - Phone:573-399-2311
Practice Address - Fax:573-399-2646
Is Sole Proprietor?:No
Enumeration Date:2015-08-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015020554363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily