Basic Information
| Provider Information | |||||||||
| NPI: | 1881138378 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRYAN | ||||||||
| FirstName: | ASHLEY | ||||||||
| MiddleName: | MEADOR | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9 W BROWNING RD | ||||||||
| Address2: | APT 2A | ||||||||
| City: | COLLINGSWOOD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 081081134 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8644662342 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1097A COOK RD | ||||||||
| Address2: | |||||||||
| City: | ORANGEBURG | ||||||||
| State: | SC | ||||||||
| PostalCode: | 291188209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8035345110 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/19/2016 | ||||||||
| LastUpdateDate: | 08/02/2018 | ||||||||
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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 | 363A00000X | 2937 | SC | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | GP6292 | 05 | SC | MEDICAID |