Provider Demographics
NPI:1790267227
Name:JOHNSON, ASHLEY (PA-C)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:
Other - Last Name:KUEBLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:600 N COTNER BLVD STE 208
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68505-2343
Mailing Address - Country:US
Mailing Address - Phone:402-464-5969
Mailing Address - Fax:402-464-3657
Practice Address - Street 1:600 N COTNER BLVD STE 208
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68505-2343
Practice Address - Country:US
Practice Address - Phone:402-464-5969
Practice Address - Fax:402-464-3657
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-31
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2256363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant