Medina, Ashley Marie Clark

Medina, Ashley Marie Clark is an individual health care provider with primary practice located at 3623 Latrobe Dr Ste 216 , Charlotte NC 28211. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Vascular & Interventional Radiology, Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant. Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant is her primary health care specialty. Medina, Ashley Marie Clark can be contacted via phone (704) 332-1291.

Contact Information

Primary practice address
3623 Latrobe Dr Ste 216 Charlotte NC 28211
Fax: (704) 332-5206
Website:

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Vascular & Interventional Radiology 2085R0204X 0010-04099 North Carolina
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 0010-04099 North Carolina

Profile Details

NPI number 1720372790
LBN Legal business name Medina, Ashley Marie Clark
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 7th, 2011
Last updated Sep 29th, 2020 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

Request for update

Identifiers

StateTypeNumberIssuer
All States NPI 1720372790 NPPES
Florida Other Y08KY BLUE CROSS BLUE SHIELD
Florida MEDICAID 133176 BLUE CROSS BLUE SHIELD

Popular Providers