NPIMap

Individual provider Active NPI

Ashley Nicole Vettleson, PA-C

  • Physician Assistant
  • Thief River Falls, MN
National Provider Identifier
1861121089
Registry record updated Jan 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
14720 Issued in MN
Practice address
1845 Hwy 59 S
Suite 800
Thief River Falls, MN 56701-4336
Phone
(218) 681-7280
NPI assigned
Jun 6, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 8, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X
Physician Assistant 363A00000X 14720 MN Primary
Physician Assistant 363A00000X PAC1043 ND

Addresses

Primary practice location

1845 Hwy 59 S
Suite 800
Thief River Falls, MN 56701-4336

Mailing address

3065 Demers Ave
Grand Forks, ND 58201
Phone (701) 780-1891

Other names 1

  • Ashley Nicole Longtin Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND, MN2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20231121003843 ND Practitioner - Physician Assistant 5294183786 Reassigns benefits to 1 organization
I20231205000194 MN Practitioner - Physician Assistant 5294183786 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Altru Health SystemGroup PAC ID 1355251604, 675 clinicians

Practice addresses (Care Compare)

1845 Hwy 59 S
Thief River Falls, MN 56701-4318
Phone (218) 681-7280

23076 347TH St SE
Erskine, MN 56535-9466
Phone (218) 687-5317

400 S Minnesota St
Crookston, MN 56716-1808
Phone (218) 281-9100

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Altru Health System CurrentSince Nov 13, 2023 Accepting new patients
Altru Health System CurrentSince Nov 5, 2023 Accepting new patients
Altru Health System CurrentSince Nov 5, 2023 Accepting new patients
Altru Health System Past Accepting new patients

Locations

400 S Minnesota St
Crookston, MN 56716
Phone (218) 281-9100

23076 347th St SE
Erskine, MN 56535
Phone (218) 435-1133

23076 347th St SE
Fl 1
Erskine, MN 56535

711 Delmore Dr
Roseau, MN 56751
Phone (218) 463-1365

1845 US Highway 59 SE
Ste 800
Thief River Falls, MN 56701
Phone (218) 681-7280

2401 Demers Ave
Grand Forks, ND 58201
Phone (701) 780-1891

1380 S Columbia Rd
Grand Forks, ND 58201
Phone (701) 795-2000

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 13

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 13

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1654473600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704672000000",
    "number": "1861121089",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3065 DEMERS AVE",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "58201",
            "telephone_number": "701-780-1891"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1845 HWY 59 S",
            "address_2": "SUITE 800",
            "city": "THIEF RIVER FALLS",
            "state": "MN",
            "postal_code": "567014336",
            "telephone_number": "218-681-7280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VETTLESON",
        "first_name": "ASHLEY",
        "middle_name": "NICOLE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-06-06",
        "last_updated": "2024-01-08",
        "certification_date": "2023-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "14720",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ND",
            "license": "PAC1043",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ASHLEY",
            "last_name": "LONGTIN",
            "middle_name": "NICOLE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Thief River Falls, MN

Sources for this page

Verify at the official NPI Registry.