Basic Information
| Provider Information | |||||||||
| NPI: | 1881702454 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ASHINHURST | ||||||||
| FirstName: | DEBORAH | ||||||||
| MiddleName: | G. | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | STOCKTON | ||||||||
| OtherFirstName: | DEBORAH | ||||||||
| OtherMiddleName: | G | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3066 SW GRANDSTAND CIR | ||||||||
| Address2: | |||||||||
| City: | LEES SUMMIT | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640813866 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8166079666 | ||||||||
| FaxNumber: | 8164473932 | ||||||||
| Practice Location | |||||||||
| Address1: | 608 MISSOURI ST | ||||||||
| Address2: | |||||||||
| City: | WAVERLY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640968241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6604932262 | ||||||||
| FaxNumber: | 6604932796 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/25/2006 | ||||||||
| LastUpdateDate: | 05/16/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 109104 | MO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 595956103 | 05 | MO | MEDICAID | 595956202 | 05 | MO | MEDICAID | 595985805 | 05 | MO | MEDICAID | 540568508 | 05 | MO | MEDICAID | 010568509 | 05 | MO | MEDICAID | 599225901 | 05 | MO | MEDICAID | 595956400 | 05 | MO | MEDICAID |