Provider Demographics
NPI:1396330098
Name:LONGBINE, ASHLEY LORENE (FNP)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:LORENE
Last Name:LONGBINE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:LORENE
Other - Last Name:RILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2000 S MAYS ST STE 201
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-7580
Mailing Address - Country:US
Mailing Address - Phone:512-492-3743
Mailing Address - Fax:512-593-4444
Practice Address - Street 1:1901 MEDI PARK DR STE 2
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-2105
Practice Address - Country:US
Practice Address - Phone:806-350-7918
Practice Address - Fax:806-418-8982
Is Sole Proprietor?:No
Enumeration Date:2021-03-04
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1031597363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1N6011OtherPTAN