Provider Demographics
NPI:1902039654
Name:MICHAELS, ASHLEY L (PA)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:L
Last Name:MICHAELS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:B
Other - Last Name:LONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:336-856-0801
Mailing Address - Fax:336-856-2804
Practice Address - Street 1:1236 GUILFORD COLLEGE RD
Practice Address - Street 2:SUITE 117
Practice Address - City:JAMESTOWN
Practice Address - State:NC
Practice Address - Zip Code:27282-9810
Practice Address - Country:US
Practice Address - Phone:336-856-0801
Practice Address - Fax:336-856-2804
Is Sole Proprietor?:No
Enumeration Date:2009-08-28
Last Update Date:2020-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-01966363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8101772Medicaid
NC8101772Medicaid