Provider Demographics
NPI:1720402464
Name:ASH, CONNIE KAY (APRN)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:KAY
Last Name:ASH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1521 N 10TH ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:BLYTHEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72315-1405
Mailing Address - Country:US
Mailing Address - Phone:870-762-5360
Mailing Address - Fax:
Practice Address - Street 1:1521 N 10TH ST
Practice Address - Street 2:SUITE C
Practice Address - City:BLYTHEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72315-1405
Practice Address - Country:US
Practice Address - Phone:870-762-5360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-18
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004039363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily