Provider Demographics
NPI:1720624430
Name:ASHMORE, MAGHAN (FNP-BC)
Entity Type:Individual
Prefix:
First Name:MAGHAN
Middle Name:
Last Name:ASHMORE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 E SUNFLOWER RD STE 100A
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:MS
Mailing Address - Zip Code:38732-2828
Mailing Address - Country:US
Mailing Address - Phone:662-843-3606
Mailing Address - Fax:662-846-7863
Practice Address - Street 1:810 E SUNFLOWER RD STE 100A
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:MS
Practice Address - Zip Code:38732-2828
Practice Address - Country:US
Practice Address - Phone:662-843-3606
Practice Address - Fax:662-846-7863
Is Sole Proprietor?:No
Enumeration Date:2019-11-18
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS903659363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS903659OtherLICENSE