Provider Demographics
NPI:1811327612
Name:ASHLEY, AMY MARIE (APRN-CNP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:MARIE
Last Name:ASHLEY
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1093
Mailing Address - Street 2:
Mailing Address - City:WEWOKA
Mailing Address - State:OK
Mailing Address - Zip Code:74884-1093
Mailing Address - Country:US
Mailing Address - Phone:405-257-3396
Mailing Address - Fax:405-257-6908
Practice Address - Street 1:1401 W 1ST ST
Practice Address - Street 2:
Practice Address - City:WEWOKA
Practice Address - State:OK
Practice Address - Zip Code:74884-5097
Practice Address - Country:US
Practice Address - Phone:405-257-3396
Practice Address - Fax:405-257-6908
Is Sole Proprietor?:No
Enumeration Date:2013-11-15
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK89487363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200521460AMedicaid