Provider Demographics
NPI:1821462045
Name:KO, ASHLEY (NP)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:KO
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:SEUNG HI
Other - Last Name:CHUN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:288 GROVELAND ST STE C3
Mailing Address - Street 2:
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01830-6674
Mailing Address - Country:US
Mailing Address - Phone:978-206-1860
Mailing Address - Fax:978-706-0006
Practice Address - Street 1:288 GROVELAND ST STE C3
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01830-6674
Practice Address - Country:US
Practice Address - Phone:978-206-1860
Practice Address - Fax:978-706-0006
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-27
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2291986363L00000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110111575AMedicaid