Provider Demographics
NPI:1790758183
Name:LARSEN, ASHLEY BARTLETTE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:BARTLETTE
Last Name:LARSEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:YVONNE
Other - Last Name:BARTLETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1112 YANCEY ST
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28150-3672
Mailing Address - Country:US
Mailing Address - Phone:704-481-7713
Mailing Address - Fax:
Practice Address - Street 1:1112 YANCEY ST
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-3672
Practice Address - Country:US
Practice Address - Phone:704-481-7713
Practice Address - Fax:704-481-7663
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC102826363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2752717AMedicare ID - Type Unspecified
NCS97286Medicare UPIN