Provider Demographics
NPI:1457825481
Name:WORTHINGTON, ASHLEY ANN
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:ANN
Last Name:WORTHINGTON
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 1:150 N MICHIGAN AVE STE 1200
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-7605
Mailing Address - Country:US
Mailing Address - Phone:312-263-4625
Mailing Address - Fax:312-263-5029
Practice Address - Street 1:7910 N SHADELAND AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-2041
Practice Address - Country:US
Practice Address - Phone:317-516-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-12
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
IN10004414A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant