Provider Demographics
NPI:1104691062
Name:RUNYON, ASHLEY ROSE (CNP)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:ROSE
Last Name:RUNYON
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:MISS
Other - First Name:ASHLEY
Other - Middle Name:R
Other - Last Name:KASPARI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:441 WILLIAMS ST
Mailing Address - Street 2:
Mailing Address - City:SCOTLAND
Mailing Address - State:SD
Mailing Address - Zip Code:57059-2047
Mailing Address - Country:US
Mailing Address - Phone:605-202-0094
Mailing Address - Fax:
Practice Address - Street 1:410 W 16TH AVE
Practice Address - Street 2:
Practice Address - City:TYNDALL
Practice Address - State:SD
Practice Address - Zip Code:57066-2318
Practice Address - Country:US
Practice Address - Phone:605-589-2190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-21
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP003030363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily