Provider Demographics
NPI:1649097114
Name:THOMPSON, ASHLEY (RN IBCLC)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:RN IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 NEUSE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27527-6693
Mailing Address - Country:US
Mailing Address - Phone:910-617-5962
Mailing Address - Fax:
Practice Address - Street 1:717 NEUSE RIDGE DR
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27527-6693
Practice Address - Country:US
Practice Address - Phone:910-617-5962
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174N00000X
NC245988163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No174N00000XOther Service ProvidersLactation Consultant, Non-RN