Basic Information
| Provider Information | |||||||||
| NPI: | 1033134283 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ASHLEY | ||||||||
| FirstName: | CARLENE | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 110 HUFFARD DR | ||||||||
| Address2: | |||||||||
| City: | BLUEFIELD | ||||||||
| State: | VA | ||||||||
| PostalCode: | 246059209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2763263376 | ||||||||
| FaxNumber: | 2763262141 | ||||||||
| Practice Location | |||||||||
| Address1: | 110 HUFFARD DR | ||||||||
| Address2: | |||||||||
| City: | BLUEFIELD | ||||||||
| State: | VA | ||||||||
| PostalCode: | 246059209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2763263376 | ||||||||
| FaxNumber: | 2763262141 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208200000X | 0102201834 | VA | Y | Allopathic & Osteopathic Physicians | Plastic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 0102201834 | 01 | VA | VIRGINIA LICENSE | OTHER |