Provider Demographics
NPI:1336630326
Name:ROBERTSON, ASHTON (PA)
Entity Type:Individual
Prefix:
First Name:ASHTON
Middle Name:
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3617 NW EXPRESSWAY
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4405
Mailing Address - Country:US
Mailing Address - Phone:405-835-2775
Mailing Address - Fax:
Practice Address - Street 1:16205 N PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-7325
Practice Address - Country:US
Practice Address - Phone:405-200-1231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-24
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2918363A00000X
TXPA15620363A00000X
ORPA207994363A00000X
WAPA.PA.61530948363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant