Basic Information
| Provider Information | |||||||||
| NPI: | 1376835215 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CRISP | ||||||||
| FirstName: | ASHLEY | ||||||||
| MiddleName: | LAUREN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3045 S NATIONAL AVE STE 110 | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 658044268 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4178886790 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3045 S NATIONAL AVE STE 110 | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 658044268 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4178886790 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2011 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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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 | 207Q00000X | 51941 | TN | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 0101256105 | VA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 2016022195 | MO | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.