Provider Demographics
NPI:1205698578
Name:COTHRON, ASHLEY LYNN
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:LYNN
Last Name:COTHRON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4614 TIM TAM CIR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-2155
Mailing Address - Country:US
Mailing Address - Phone:317-997-1802
Mailing Address - Fax:
Practice Address - Street 1:265 W COUNTY ROAD 850 S
Practice Address - Street 2:
Practice Address - City:CLAY CITY
Practice Address - State:IN
Practice Address - Zip Code:47841-8210
Practice Address - Country:US
Practice Address - Phone:317-604-0101
Practice Address - Fax:317-981-3808
Is Sole Proprietor?:No
Enumeration Date:2024-01-23
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28222473A163W00000X
IN71015650A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse