Provider Demographics
NPI:1124476395
Name:ROBERTSON, WILLIAM ASHLEY (FNP)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:ASHLEY
Last Name:ROBERTSON
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:DR
Other - First Name:WILLIAM
Other - Middle Name:ASHLEY
Other - Last Name:ROBERTSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DNP
Mailing Address - Street 1:PSC 476 BOX 25
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96322-0001
Mailing Address - Country:US
Mailing Address - Phone:315-252-2550
Mailing Address - Fax:
Practice Address - Street 1:PSC 476 BOX 25
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96322-0001
Practice Address - Country:US
Practice Address - Phone:315-252-2550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-29
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA761000163W00000X
CA95009691363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163W00000XNursing Service ProvidersRegistered Nurse