1134653314 NPI number — MRS. ASHLEY E HEFNER P.A-C

Table of content: MRS. ASHLEY E HEFNER P.A-C (NPI 1134653314)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134653314 NPI number — MRS. ASHLEY E HEFNER P.A-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HEFNER
Provider First Name:
ASHLEY
Provider Middle Name:
E
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
P.A-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MILLER
Provider Other First Name:
ASHLEY
Provider Other Middle Name:
E
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1134653314
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/02/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12700 PARK CENTRAL DRIVE
Provider Second Line Business Mailing Address:
SUITE 900
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75251
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-860-6034
Provider Business Mailing Address Fax Number:
972-852-9075

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10506 MONTGOMERY RD.
Provider Second Line Business Practice Location Address:
SUITE 209
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45242
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-865-9040
Provider Business Practice Location Address Fax Number:
513-865-9046
Provider Enumeration Date:
04/14/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AM0700X , with the licence number:  50.004995RX , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1043274418 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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