Basic Information
| Provider Information | |||||||||
| NPI: | 1598321481 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | ASHLEY | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 482 | ||||||||
| Address2: | |||||||||
| City: | HEBER | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 859280482 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9282400241 | ||||||||
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| Practice Location | |||||||||
| Address1: | 320 E DEUCE OF CLUBS | ||||||||
| Address2: | |||||||||
| City: | SHOW LOW | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 859014808 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9285323926 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2019 | ||||||||
| LastUpdateDate: | 05/15/2019 | ||||||||
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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 | 363LF0000X | 225476 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.