Provider Demographics
NPI:1295095958
Name:UNDERBRINK, ASHTON MARIE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:ASHTON
Middle Name:MARIE
Last Name:UNDERBRINK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ASHTON
Other - Middle Name:MARIE
Other - Last Name:MARSAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 4439
Mailing Address - Street 2:HOUSTON
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77210-4439
Mailing Address - Country:US
Mailing Address - Phone:713-792-6161
Mailing Address - Fax:
Practice Address - Street 1:1515 HOLCOMBE BLVD
Practice Address - Street 2:HOUSTON
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4009
Practice Address - Country:US
Practice Address - Phone:713-792-6161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-29
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA07741363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX297116001Medicaid
TX8N0375OtherBCBS
TX8N0375OtherBCBS