Provider Demographics
NPI:1780142356
Name:BINGMAN, ASHLEY RENEE (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:RENEE
Last Name:BINGMAN
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 1:832 N 10TH ST
Mailing Address - Street 2:
Mailing Address - City:BREESE
Mailing Address - State:IL
Mailing Address - Zip Code:62230-1060
Mailing Address - Country:US
Mailing Address - Phone:618-384-9645
Mailing Address - Fax:
Practice Address - Street 1:1 BRONZE POINTE BLVD STE 1A
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226-1045
Practice Address - Country:US
Practice Address - Phone:618-233-7055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-03
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209018890163WP0000X
IL1780142356363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WP0000XNursing Service ProvidersRegistered NursePain Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209018890OtherADVANCED PRACTICE REGISTERED NURSE
IL209018890OtherNURSE PRACTITIONER