Provider Demographics
NPI:1104254192
Name:MISSON, ASHLEIGH ELIZABETH (PA-C)
Entity type:Individual
Prefix:
First Name:ASHLEIGH
Middle Name:ELIZABETH
Last Name:MISSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ASHLEIGH
Other - Middle Name:ELIZABETH
Other - Last Name:HENNING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2480 WHITE BEAR AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2480 WHITE BEAR AVE N STE 104
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-4568
Practice Address - Country:US
Practice Address - Phone:612-444-3247
Practice Address - Fax:651-888-9247
Is Sole Proprietor?:No
Enumeration Date:2013-10-29
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11494363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1104254192Medicaid