Provider Demographics
NPI:1811916612
Name:GREENE, ASHLEY Y (PA-C)
Entity type:Individual
Prefix:MR
First Name:ASHLEY
Middle Name:Y
Last Name:GREENE
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8840 COMMERCE PARK PLACE
Mailing Address - Street 2:SUITE E
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-3129
Mailing Address - Country:US
Mailing Address - Phone:317-583-7600
Mailing Address - Fax:317-583-7601
Practice Address - Street 1:4301 W MARKHAM ST # 616
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-7101
Practice Address - Country:US
Practice Address - Phone:501-686-5311
Practice Address - Fax:501-686-5935
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI21961-875363A00000X
SC5688363A00000X
IN10000417A363AS0400X
ARPA-1113363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000374069OtherBCBS PIN
SC7374PAMedicaid
970012674OtherRAILROAD MEDICARE
000000374069OtherBCBS PIN
P03695Medicare UPIN
IN558430063Medicare PIN