Provider Demographics
NPI:1235977307
Name:ELIX, ASHLEY KIMTASHI (AGACNP-BC)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:KIMTASHI
Last Name:ELIX
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:KIMTASHI
Other - Last Name:KIRKENDOLL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ASHLEY KIMTASHI KIRK
Mailing Address - Street 1:1458 EVERETT GARDENS WAY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75126
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1458 EVERETT GARDENS WAY
Practice Address - Street 2:
Practice Address - City:FORNEY
Practice Address - State:TX
Practice Address - Zip Code:75126
Practice Address - Country:US
Practice Address - Phone:214-841-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1164998363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care