Provider Demographics
NPI:1396560678
Name:YU, ASHLEY RAE
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:RAE
Last Name:YU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13502 OAK GROVE CT
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74804-6601
Mailing Address - Country:US
Mailing Address - Phone:405-695-2990
Mailing Address - Fax:
Practice Address - Street 1:1509 N SHAWNEE AVE
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74804-4163
Practice Address - Country:US
Practice Address - Phone:405-695-2990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-20
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator