Provider Demographics
NPI:1740925411
Name:STEVENSON, ASHLEY LACHELLE
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:LACHELLE
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:531 BLACKEARTH CT
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-5501
Mailing Address - Country:US
Mailing Address - Phone:314-365-6499
Mailing Address - Fax:
Practice Address - Street 1:531 BLACKEARTH CT
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-5501
Practice Address - Country:US
Practice Address - Phone:314-365-6499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-28
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide