Provider Demographics
NPI:1861034787
Name:LAPORTE, ASHLIE AVILES (PA-C)
Entity Type:Individual
Prefix:
First Name:ASHLIE
Middle Name:AVILES
Last Name:LAPORTE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ASHLIE
Other - Middle Name:MARIE
Other - Last Name:AVILES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3853 BOSTON RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40514-1550
Mailing Address - Country:US
Mailing Address - Phone:270-994-5712
Mailing Address - Fax:
Practice Address - Street 1:1140 LEXINGTON RD
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-9330
Practice Address - Country:US
Practice Address - Phone:502-868-1215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-11
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant