Basic Information
| Provider Information | |||||||||
| NPI: | 1134653314 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HEFNER | ||||||||
| FirstName: | ASHLEY | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | P.A-C | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MILLER | ||||||||
| OtherFirstName: | ASHLEY | ||||||||
| OtherMiddleName: | E | ||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | PA C | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 12700 PARK CENTRAL DRIVE | ||||||||
| Address2: | SUITE 900 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75251 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2148606034 | ||||||||
| FaxNumber: | 9728529075 | ||||||||
| Practice Location | |||||||||
| Address1: | 10506 MONTGOMERY RD. | ||||||||
| Address2: | SUITE 209 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45242 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5138659040 | ||||||||
| FaxNumber: | 5138659046 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/14/2017 | ||||||||
| LastUpdateDate: | 01/02/2019 | ||||||||
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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 | 363AM0700X | 50.004995RX | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | 1043274418 | 05 | OH | MEDICAID |