Provider Demographics
NPI:1679689459
Name:ASHLEY, CHANTEL LATRESA (CNM)
Entity Type:Individual
Prefix:
First Name:CHANTEL
Middle Name:LATRESA
Last Name:ASHLEY
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8714 SPRING CYPRESS RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-3395
Mailing Address - Country:US
Mailing Address - Phone:281-251-6394
Mailing Address - Fax:
Practice Address - Street 1:8714 SPRING CYPRESS RD
Practice Address - Street 2:SUITE 200
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-3395
Practice Address - Country:US
Practice Address - Phone:281-251-6394
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX626367367A00000X, 176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8FX389OtherBLUE CROSS BLUE SHIELD
TX8339NHOtherBLUE CROSS BLUE SHIELD
TX206275403Medicaid
TX8L13238Medicare UPIN
TX206275403Medicaid
TX8339NHOtherBLUE CROSS BLUE SHIELD