Provider Demographics
NPI:1871281832
Name:LEGG, ASHLEY (PA-C)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:
Last Name:LEGG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:ASHLEY
Other - Middle Name:
Other - Last Name:LOWNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:6676 NORTHVIEW DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-1530
Mailing Address - Country:US
Mailing Address - Phone:810-706-1899
Mailing Address - Fax:
Practice Address - Street 1:6676 NORTHVIEW DR
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-1530
Practice Address - Country:US
Practice Address - Phone:810-706-1899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-27
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601011710363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant