Provider Demographics
NPI:1679538102
Name:ASHTON, LISA O (APRN-FNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:O
Last Name:ASHTON
Suffix:
Gender:F
Credentials:APRN-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 CHEROKEE ROSE LANE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433
Mailing Address - Country:US
Mailing Address - Phone:985-893-0911
Mailing Address - Fax:985-875-7565
Practice Address - Street 1:606 W 12TH AVE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-3358
Practice Address - Country:US
Practice Address - Phone:985-892-2252
Practice Address - Fax:985-893-6636
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP03513363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1432351Medicaid
4B577Medicare ID - Type Unspecified
LA1432351Medicaid
LA4B577CB84Medicare PIN
S19073Medicare UPIN