Provider Demographics
NPI:1457046120
Name:SPANN, ASHLEE NACOLE
Entity Type:Individual
Prefix:
First Name:ASHLEE
Middle Name:NACOLE
Last Name:SPANN
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 1:1905 MARGARET DR APT 2072
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76306-1819
Mailing Address - Country:US
Mailing Address - Phone:940-257-5784
Mailing Address - Fax:
Practice Address - Street 1:609 ELM AVE
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76704-2516
Practice Address - Country:US
Practice Address - Phone:254-313-6900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program