Provider Demographics
NPI:1780141655
Name:SELDERS, ASHLEY LACHEY
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:LACHEY
Last Name:SELDERS
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 1:23502 PRAIRIE BIRD DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77373-6674
Mailing Address - Country:US
Mailing Address - Phone:832-757-8966
Mailing Address - Fax:
Practice Address - Street 1:23502 PRAIRIE BIRD DR
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77373-6674
Practice Address - Country:US
Practice Address - Phone:832-757-8966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-26
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX347376164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse