Provider Demographics
NPI:1689083511
Name:SANDBOTHE, ASHLEY R (CFNP)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:R
Last Name:SANDBOTHE
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3527 W TRUMAN BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65109-5715
Mailing Address - Country:US
Mailing Address - Phone:573-761-7979
Mailing Address - Fax:573-761-5515
Practice Address - Street 1:3527 W TRUMAN BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-5715
Practice Address - Country:US
Practice Address - Phone:573-761-7979
Practice Address - Fax:573-761-5515
Is Sole Proprietor?:No
Enumeration Date:2014-08-05
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2014012869363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO151900008Medicare PIN