Provider Demographics
NPI:1245985225
Name:ASHLEY, MARK LEE
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:LEE
Last Name:ASHLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1003 FLEMING AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-2339
Mailing Address - Country:US
Mailing Address - Phone:520-809-3401
Mailing Address - Fax:
Practice Address - Street 1:1003 FLEMING AVE
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-2339
Practice Address - Country:US
Practice Address - Phone:520-809-3401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-17
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant