Provider Demographics
NPI:1881361673
Name:KING, ASHLEY ROSE (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:ROSE
Last Name:KING
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3738 FM 972
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626-1501
Mailing Address - Country:US
Mailing Address - Phone:512-924-1009
Mailing Address - Fax:
Practice Address - Street 1:3738 FM 972
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-1501
Practice Address - Country:US
Practice Address - Phone:512-924-1009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-27
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1052588363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily