Provider Demographics
NPI:1780190637
Name:PETERSON, ASHLEY GLAUDI (FNP)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:GLAUDI
Last Name:PETERSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:GLAUDI
Other - Last Name:PETERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:5001 HIGHWAY 190 EAST SERVICE RD STE D
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-4930
Mailing Address - Country:US
Mailing Address - Phone:985-805-2555
Mailing Address - Fax:985-400-5303
Practice Address - Street 1:5001 HIGHWAY 190 EAST SERVICE RD STE D
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-4930
Practice Address - Country:US
Practice Address - Phone:985-805-2555
Practice Address - Fax:985-400-5303
Is Sole Proprietor?:No
Enumeration Date:2017-12-14
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP09655363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily