Provider Demographics
NPI:1710398912
Name:WISE, ASHTON E (LSA, OPA-C)
Entity Type:Individual
Prefix:MS
First Name:ASHTON
Middle Name:E
Last Name:WISE
Suffix:
Gender:F
Credentials:LSA, OPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6347 S CUSTER RD
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-3465
Mailing Address - Country:US
Mailing Address - Phone:469-885-8555
Mailing Address - Fax:
Practice Address - Street 1:6347 S CUSTER RD
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-3465
Practice Address - Country:US
Practice Address - Phone:469-363-6070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-11
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical