Provider Demographics
NPI:1730840695
Name:CLEVENGER, ASHLEY KRISTINA
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:KRISTINA
Last Name:CLEVENGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:526 CORONA AVE APT B
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45419-2207
Mailing Address - Country:US
Mailing Address - Phone:317-432-1858
Mailing Address - Fax:
Practice Address - Street 1:110 N MAIN ST STE 350
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45402-3735
Practice Address - Country:US
Practice Address - Phone:937-499-8263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-04
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.00733RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant