Provider Demographics
NPI:1700174919
Name:DAVIS, ASHLYNN RENEE (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:ASHLYNN
Middle Name:RENEE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6230 BUSCH BLVD STE 217
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-1863
Mailing Address - Country:US
Mailing Address - Phone:614-584-4726
Mailing Address - Fax:
Practice Address - Street 1:6230 BUSCH BLVD STE 217
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-1863
Practice Address - Country:US
Practice Address - Phone:614-505-6007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-21
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401244750511376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH5138336Medicaid
OH0402859Medicaid