Provider Demographics
NPI:1013254358
Name:HOUSE, ASHLEY BARQ (FNP-C)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:BARQ
Last Name:HOUSE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1810
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39502-1810
Mailing Address - Country:US
Mailing Address - Phone:228-867-6062
Mailing Address - Fax:228-867-2598
Practice Address - Street 1:4540 W RAILROAD ST
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39501-2480
Practice Address - Country:US
Practice Address - Phone:228-867-6062
Practice Address - Fax:228-867-2598
Is Sole Proprietor?:No
Enumeration Date:2013-01-07
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR871615363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily