Active NPI
Ashlan Nicole Derouen
- Medical Physician Assistant
- Baltimore, MD
National Provider Identifier
1851204663
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- Practice address
- 4940 Eastern Ave
Baltimore, MD 21224-2735 - Phone
- (410) 550-0100
- NPI assigned
- Sep 23, 2026
- Last updated
- Sep 23, 2026
- 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 |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | NU | Primary |
Addresses
Primary practice location
4940 Eastern Ave
Baltimore, MD 21224-2735
Mailing address
123 Austin Rd
Youngsville, LA 70592-6307
Phone (337) 354-6081
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1790121600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1790121600000",
"number": "1851204663",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "123 AUSTIN RD",
"city": "YOUNGSVILLE",
"state": "LA",
"postal_code": "705926307",
"telephone_number": "337-354-6081"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4940 EASTERN AVE",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212242735",
"telephone_number": "410-550-0100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEROUEN",
"first_name": "ASHLAN",
"middle_name": "NICOLE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2026-09-23",
"last_updated": "2026-09-23",
"certification_date": "2026-09-23",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Baltimore, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.