Provider Demographics
NPI:1790460525
Name:WALTON, ASHLEY MARIE (FNP-C)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:MARIE
Last Name:WALTON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 CHRISTOPHER COLUMBUS DR APT 3009
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-5141
Mailing Address - Country:US
Mailing Address - Phone:717-579-2878
Mailing Address - Fax:
Practice Address - Street 1:111 BROADWAY
Practice Address - Street 2:SUITE 504
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10006
Practice Address - Country:US
Practice Address - Phone:212-571-3331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY352180363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily