Provider Demographics
NPI:1356755177
Name:SMITH, ASHDEN NICHOLE (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:ASHDEN
Middle Name:NICHOLE
Last Name:SMITH
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:ASHDEN
Other - Middle Name:NICHOLE
Other - Last Name:BRATTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2550 LUSK DR
Mailing Address - Street 2:
Mailing Address - City:NEOSHO
Mailing Address - State:MO
Mailing Address - Zip Code:64850-8855
Mailing Address - Country:US
Mailing Address - Phone:417-451-2060
Mailing Address - Fax:
Practice Address - Street 1:2550 LUSK DR
Practice Address - Street 2:
Practice Address - City:NEOSHO
Practice Address - State:MO
Practice Address - Zip Code:64850
Practice Address - Country:US
Practice Address - Phone:417-451-2060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-19
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013038351363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily