Provider Demographics
NPI:1164238077
Name:CUMBERLEDGE, ASHLEY NICOLE (PA-C)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:NICOLE
Last Name:CUMBERLEDGE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 306
Mailing Address - Street 2:
Mailing Address - City:ROGERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15359-0306
Mailing Address - Country:US
Mailing Address - Phone:724-833-5067
Mailing Address - Fax:
Practice Address - Street 1:401 DIVISION ST STE 304
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-1455
Practice Address - Country:US
Practice Address - Phone:304-767-7840
Practice Address - Fax:304-767-7849
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-05
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00893800363A00000X
PAMA066152363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant