Provider Demographics
NPI:1922303734
Name:BEMO, ASHLEY GAIL (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:GAIL
Last Name:BEMO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:ASHLEY
Other - Middle Name:GAIL
Other - Last Name:FARMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2600 OTTAWA RD
Mailing Address - Street 2:
Mailing Address - City:NEODESHA
Mailing Address - State:KS
Mailing Address - Zip Code:66757-1897
Mailing Address - Country:US
Mailing Address - Phone:620-325-2611
Mailing Address - Fax:
Practice Address - Street 1:2600 OTTAWA RD
Practice Address - Street 2:
Practice Address - City:NEODESHA
Practice Address - State:KS
Practice Address - Zip Code:66757-1897
Practice Address - Country:US
Practice Address - Phone:620-325-2622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-26
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2003363A00000X, 363AM0700X
KS15-02588363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical