Provider Demographics
NPI:1881139046
Name:HEADLEY, ASHLEY M (CRNP)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:M
Last Name:HEADLEY
Suffix:
Gender:
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1034 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-2945
Mailing Address - Country:US
Mailing Address - Phone:814-333-5736
Mailing Address - Fax:814-333-5819
Practice Address - Street 1:180 N FRANKLIN ST STE B
Practice Address - Street 2:
Practice Address - City:COCHRANTON
Practice Address - State:PA
Practice Address - Zip Code:16314-9706
Practice Address - Country:US
Practice Address - Phone:814-425-1126
Practice Address - Fax:814-425-1156
Is Sole Proprietor?:No
Enumeration Date:2016-12-27
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN634066163W00000X
PASP017122363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA3528142OtherHIGMARK
PAMH4244240OtherDEA
PAMH4244240OtherDEA