Provider Demographics
NPI:1689224784
Name:STEVENS, ASHLY DAWN
Entity Type:Individual
Prefix:
First Name:ASHLY
Middle Name:DAWN
Last Name:STEVENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9805 E 21ST PL APT C
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74129-3818
Mailing Address - Country:US
Mailing Address - Phone:918-565-1361
Mailing Address - Fax:
Practice Address - Street 1:9805 E 21ST PL APT C
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74129-3818
Practice Address - Country:US
Practice Address - Phone:918-565-1361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-19
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist