Provider Demographics
NPI:1053701664
Name:ASHLEYATP, CARRIE (ATP 79399)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:ASHLEYATP
Suffix:
Gender:F
Credentials:ATP 79399
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:
Other - Last Name:MOREMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1701 OLD MINDEN ROAD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-4849
Mailing Address - Country:US
Mailing Address - Phone:318-752-2273
Mailing Address - Fax:
Practice Address - Street 1:1701 OLD MINDEN ROAD
Practice Address - Street 2:SUITE 6
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-4849
Practice Address - Country:US
Practice Address - Phone:318-752-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-03
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
ATP79399OtherATP