Basic Information
| Provider Information | |||||||||
| NPI: | 1679987705 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TERRY | ||||||||
| FirstName: | ASHLEY | ||||||||
| MiddleName: | E. | ||||||||
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| Credential: | APRN | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | FOWLKES | ||||||||
| OtherFirstName: | ASHLEY | ||||||||
| OtherMiddleName: | E. | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 7800 COLLEGE BLVD. | ||||||||
| Address2: | STE. 200 | ||||||||
| City: | OVERLAND PARK | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662101870 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9134913999 | ||||||||
| FaxNumber: | 9134919309 | ||||||||
| Practice Location | |||||||||
| Address1: | 8101 W 135TH ST | ||||||||
| Address2: | STE. 200 | ||||||||
| City: | OVERLAND PARK | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662231111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9134913999 | ||||||||
| FaxNumber: | 9134919309 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2014 | ||||||||
| LastUpdateDate: | 06/17/2014 | ||||||||
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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 | 76312 | KS | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.