Provider Demographics
NPI:1790146520
Name:WALDROP, ASHLEY MARIE
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:MARIE
Last Name:WALDROP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:MARIE
Other - Last Name:MOAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:201 WALLS DR
Mailing Address - Street 2:SUITE 501
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76033-4007
Mailing Address - Country:US
Mailing Address - Phone:817-641-8800
Mailing Address - Fax:
Practice Address - Street 1:201 WALLS DR
Practice Address - Street 2:SUITE 501
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033-4007
Practice Address - Country:US
Practice Address - Phone:817-641-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-07
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant