Provider Demographics
NPI:1255059820
Name:ASHTON, ANDREW
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:ASHTON
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:PO BOX 873158
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99687-3158
Mailing Address - Country:US
Mailing Address - Phone:319-321-9666
Mailing Address - Fax:800-909-7183
Practice Address - Street 1:2851 E PALMER WASILLA HWY STE 3
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7499
Practice Address - Country:US
Practice Address - Phone:907-357-7944
Practice Address - Fax:800-909-7183
Is Sole Proprietor?:No
Enumeration Date:2022-08-18
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK215533363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant