Provider Demographics
NPI:1851619605
Name:GOODALL, ASHLEY R (PA)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:R
Last Name:GOODALL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:5501 GORDON SMITH DR STE 500
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75089-3209
Mailing Address - Country:US
Mailing Address - Phone:214-703-8100
Mailing Address - Fax:214-703-3269
Practice Address - Street 1:5501 GORDON SMITH DR STE 500
Practice Address - Street 2:
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75089-3209
Practice Address - Country:US
Practice Address - Phone:214-703-8100
Practice Address - Fax:214-703-3269
Is Sole Proprietor?:No
Enumeration Date:2010-05-04
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA06124363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB103203Medicare PIN
TXTXB103202Medicare PIN
TXTXB103201Medicare PIN