Active NPI
Kelly M Ashley, CPNP
- Pediatric Nurse Practitioner
- Dothan, AL
National Provider Identifier
1063764447
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Nurse Practitioner
- License
- 1-093975
- Practice address
- 364 Honeysuckle Road
Dothan, AL 36305-1140 - Phone
- (334) 794-8656
- Fax
- (334) 702-7047
- NPI assigned
- Oct 9, 2012
- Last updated
- Oct 10, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Nurse Practitioner | 363LP0200X | 1-093975 | AL | Primary |
Addresses
Primary practice location
364 Honeysuckle Road
Dothan, AL 36305-1140
Mailing address
364 Honeysuckle Road
Dothan, AL 36305-1140
Phone (334) 794-8656
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 515-15001 | Other | AL | BCBS OF AL |
| 891005040 | Medicaid | AL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Certified Pediatric Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1-093975 | AL | MD | Pediatric Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southeastern Pediatric Associates, P.a. | Past | Accepting new patients |
Interoperability endpoints
- https://fhir.meditouchehr.com/api/fhir/r4/
- kelly.ashley@371161182240772.direct.elationemr.com
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Pediatrics Physician
- Dothan, AL
- NPI 1093907412
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1349740800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1349827200000",
"number": "1063764447",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "364 HONEYSUCKLE ROAD",
"city": "DOTHAN",
"state": "AL",
"postal_code": "363051140",
"telephone_number": "334-794-8656",
"fax_number": "334-702-7047"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "364 HONEYSUCKLE ROAD",
"city": "DOTHAN",
"state": "AL",
"postal_code": "363051140",
"telephone_number": "334-794-8656",
"fax_number": "334-702-7047"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ASHLEY",
"first_name": "KELLY",
"middle_name": "M",
"credential": "CPNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-10-09",
"last_updated": "2012-10-10",
"status": "A"
},
"taxonomies": [
{
"code": "363LP0200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Pediatrics",
"state": "AL",
"license": "1-093975",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS OF AL",
"identifier": "515-15001",
"state": "AL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "891005040",
"state": "AL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Dothan, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.