Provider Demographics
NPI:1902857469
Name:ASHMORE, KATHERINE J (NP)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:J
Last Name:ASHMORE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:H
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2799 W GRAND BOULEVARD
Mailing Address - Street 2:K14 CARDIOLOGY
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202
Mailing Address - Country:US
Mailing Address - Phone:313-461-9110
Mailing Address - Fax:313-916-8416
Practice Address - Street 1:2799 W GRAND BOULEVARD
Practice Address - Street 2:K14 CARDIOLOGY
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202
Practice Address - Country:US
Practice Address - Phone:313-461-9110
Practice Address - Fax:313-916-8416
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704169669363LG0600X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI4989OtherGROUP MEDICARE PIN
MI104517792Medicaid
MIP00019217OtherMETRAHEALTH RR
MI1295023547OtherGROUP NPI TYPE II (MICHIGAN HEALTHCARE PROFESSIONALS, PC
MIP00019217OtherMETRAHEALTH RR