Provider Demographics
NPI:1891259446
Name:WILES, ASHLEY RAE (MSN, FNP-C)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:RAE
Last Name:WILES
Suffix:
Gender:F
Credentials:MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4010 S JACKSON DR APT 105
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64057-1996
Mailing Address - Country:US
Mailing Address - Phone:816-377-6697
Mailing Address - Fax:
Practice Address - Street 1:5100 W 110TH ST STE 300
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-1215
Practice Address - Country:US
Practice Address - Phone:913-754-2800
Practice Address - Fax:913-754-2899
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-29
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019002762363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily