Provider Demographics
NPI:1912043399
Name:RANE, ASHLEY LEIGH (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:LEIGH
Last Name:RANE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:LEIGH
Other - Last Name:MADDOX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 729
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36302-0729
Mailing Address - Country:US
Mailing Address - Phone:334-793-2663
Mailing Address - Fax:334-836-2248
Practice Address - Street 1:1500 ROSS CLARK CIR
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-4754
Practice Address - Country:US
Practice Address - Phone:334-793-2663
Practice Address - Fax:334-836-2248
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL364363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL511-10951OtherBCBS OF AL - RCC
GA003140907AMedicaid
GA003140909AMedicaid
AL124238Medicaid
AL125083Medicaid
AL511-10973OtherBCBS OF AL - HEALTHWEST
ALQ04949Medicare UPIN
AL511-10973OtherBCBS OF AL - HEALTHWEST