Provider Demographics
NPI:1700557212
Name:SMITH, ASHLEY NICOEL (DNP, FNP-C)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:NICOEL
Last Name:SMITH
Suffix:
Gender:F
Credentials:DNP, FNP-C
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:NICOEL
Other - Last Name:WITHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2801 ST ANTHONY WAY
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:OR
Mailing Address - Zip Code:97801-3800
Mailing Address - Country:US
Mailing Address - Phone:541-966-0535
Mailing Address - Fax:
Practice Address - Street 1:2801 ST ANTHONY WAY
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801-3800
Practice Address - Country:US
Practice Address - Phone:541-966-0535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR202110446NP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR202110446NP-PPOtherOREGON STATE BOARD OF NURSING