Provider Demographics
NPI:1730833443
Name:ASHLEY, EVAN C (FNP)
Entity type:Individual
Prefix:MR
First Name:EVAN
Middle Name:C
Last Name:ASHLEY
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 FOURTH ST
Mailing Address - Street 2:
Mailing Address - City:JONESVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71343-2123
Mailing Address - Country:US
Mailing Address - Phone:318-403-6080
Mailing Address - Fax:
Practice Address - Street 1:1305 FOURTH ST
Practice Address - Street 2:
Practice Address - City:JONESVILLE
Practice Address - State:LA
Practice Address - Zip Code:71343-2123
Practice Address - Country:US
Practice Address - Phone:318-403-6080
Practice Address - Fax:318-403-6087
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-10
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA224268363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2584235Medicaid