Provider Demographics
NPI:1154925964
Name:MOORE, ASHLEY NICOLE (NP)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:NICOLE
Last Name:MOORE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:49933 ZEP RD W
Mailing Address - Street 2:
Mailing Address - City:SARAHSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43779-9783
Mailing Address - Country:US
Mailing Address - Phone:740-509-8203
Mailing Address - Fax:
Practice Address - Street 1:807 FARSON ST STE 230
Practice Address - Street 2:
Practice Address - City:BELPRE
Practice Address - State:OH
Practice Address - Zip Code:45714-1068
Practice Address - Country:US
Practice Address - Phone:740-568-4590
Practice Address - Fax:740-568-4592
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-23
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.025436363L00000X
OHCNP.025436207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology