Provider Demographics
NPI:1770082190
Name:GAVELEK, ASHLEY KEEN (FNP-C)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:KEEN
Last Name:GAVELEK
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2402 OSLER CT
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31707-0205
Mailing Address - Country:US
Mailing Address - Phone:229-438-3302
Mailing Address - Fax:229-438-3384
Practice Address - Street 1:2402 OSLER CT
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707-0205
Practice Address - Country:US
Practice Address - Phone:229-438-3302
Practice Address - Fax:229-438-3384
Is Sole Proprietor?:No
Enumeration Date:2018-02-12
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN220556363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily