Provider Demographics
NPI:1508418864
Name:POLKINGHORN, ASHLEE (PA-C)
Entity Type:Individual
Prefix:
First Name:ASHLEE
Middle Name:
Last Name:POLKINGHORN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10509 PROFESSIONAL CIR
Mailing Address - Street 2:STE 101
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521-4883
Mailing Address - Country:US
Mailing Address - Phone:419-377-7164
Mailing Address - Fax:
Practice Address - Street 1:10509 PROFESSIONAL CIR STE 101
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-4883
Practice Address - Country:US
Practice Address - Phone:775-323-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-16
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NVPA2357207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program