Provider Demographics
NPI:1871319152
Name:WILSON, ASHLEY C (RN)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:C
Last Name:WILSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:778 STATE HIGHWAY FF
Mailing Address - Street 2:
Mailing Address - City:FORDLAND
Mailing Address - State:MO
Mailing Address - Zip Code:65652-7410
Mailing Address - Country:US
Mailing Address - Phone:417-988-6442
Mailing Address - Fax:
Practice Address - Street 1:133 MEADOWBROOK LN
Practice Address - Street 2:
Practice Address - City:FORDLAND
Practice Address - State:MO
Practice Address - Zip Code:65652-7204
Practice Address - Country:US
Practice Address - Phone:417-860-5232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-02
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20190371233747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant