Provider Demographics
NPI:1457580193
Name:KENTOSKI, ASHLEY M (PA)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:M
Last Name:KENTOSKI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:90 BEAVER DR STE 215D
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-2442
Mailing Address - Country:US
Mailing Address - Phone:814-503-8368
Mailing Address - Fax:814-503-8562
Practice Address - Street 1:90 BEAVER DR STE 215D
Practice Address - Street 2:
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-2442
Practice Address - Country:US
Practice Address - Phone:814-503-8368
Practice Address - Fax:814-503-8562
Is Sole Proprietor?:No
Enumeration Date:2009-07-02
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMA053865363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant