Provider Demographics
NPI:1750836979
Name:ALLEN, ASHLEY (FNP)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1099 WINTERSON RD STE 300
Mailing Address - Street 2:
Mailing Address - City:LINTHICUM HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:21090-2279
Mailing Address - Country:US
Mailing Address - Phone:800-905-3261
Mailing Address - Fax:443-836-5606
Practice Address - Street 1:1036 SAINT NICHOLAS DR UNIT 101
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20603-4758
Practice Address - Country:US
Practice Address - Phone:240-261-7170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-17
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR252760363LF0000X
NVAPRN002326363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV114952Medicare PIN