Provider Demographics
NPI:1538707666
Name:SMITH, ASHLEY J (FNP-PP)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:J
Last Name:SMITH
Suffix:
Gender:F
Credentials:FNP-PP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4801 N BUTLER AVE STE 8102
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-0818
Mailing Address - Country:US
Mailing Address - Phone:505-370-1201
Mailing Address - Fax:505-461-1779
Practice Address - Street 1:4801 N BUTLER AVE STE 8102
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-0818
Practice Address - Country:US
Practice Address - Phone:505-370-1201
Practice Address - Fax:505-461-1779
Is Sole Proprietor?:No
Enumeration Date:2019-12-19
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM60399163W00000X
CORXN-004753-NP363LF0000X
COAPN0995538-NP363LF0000X, 363LF0000X
NMCNP60399363LF0000X, 363LF0000X
OR202000538NP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM30521041Medicaid
NM60399OtherLICENSE