Provider Demographics
NPI:1790319333
Name:LOPEZ, ASHLEY M (CNM)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:M
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:JO
Other - Last Name:MARRATTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:575 HILL COUNTRY DR STE 101
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-6024
Mailing Address - Country:US
Mailing Address - Phone:830-258-7288
Mailing Address - Fax:830-258-7678
Practice Address - Street 1:575 HILL COUNTRY DR STE 202
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-6024
Practice Address - Country:US
Practice Address - Phone:830-258-6237
Practice Address - Fax:830-315-1366
Is Sole Proprietor?:No
Enumeration Date:2020-02-22
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP145829176B00000X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX411547901Medicaid
CNM06220OtherCERTIFICATION NUMBER