Provider Demographics
NPI:1548943293
Name:SIMON, ASHLEY TAYLOR
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:TAYLOR
Last Name:SIMON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:TAYLOR
Other - Last Name:SCHWAB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 650859
Mailing Address - Street 2:DEPT 710
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75265
Mailing Address - Country:US
Mailing Address - Phone:409-772-2222
Mailing Address - Fax:
Practice Address - Street 1:1005 HARBORSIDE DR FL 6
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77555-0100
Practice Address - Country:US
Practice Address - Phone:409-772-0122
Practice Address - Fax:409-772-0777
Is Sole Proprietor?:No
Enumeration Date:2023-08-09
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA17161363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant