Provider Demographics
NPI:1063059616
Name:KLONK, ASHLEY R
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:R
Last Name:KLONK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2114 STATE ROUTE 113 E
Mailing Address - Street 2:
Mailing Address - City:MILAN
Mailing Address - State:OH
Mailing Address - Zip Code:44846-9483
Mailing Address - Country:US
Mailing Address - Phone:419-499-7600
Mailing Address - Fax:
Practice Address - Street 1:2114 STATE ROUTE 113 E
Practice Address - Street 2:
Practice Address - City:MILAN
Practice Address - State:OH
Practice Address - Zip Code:44846-9483
Practice Address - Country:US
Practice Address - Phone:419-499-7600
Practice Address - Fax:419-499-7300
Is Sole Proprietor?:No
Enumeration Date:2019-12-03
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.025892363LF0000X
OH025892363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily