Provider Demographics
NPI:1215786819
Name:COUCH, ASHLEY AMBER (NP)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:AMBER
Last Name:COUCH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:AMBER
Other - Last Name:FARNSWORTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12323 N FEATHER SONG AVE
Mailing Address - Street 2:
Mailing Address - City:MARANA
Mailing Address - State:AZ
Mailing Address - Zip Code:85658-4697
Mailing Address - Country:US
Mailing Address - Phone:520-256-6035
Mailing Address - Fax:
Practice Address - Street 1:12323 N FEATHER SONG AVE
Practice Address - Street 2:
Practice Address - City:MARANA
Practice Address - State:AZ
Practice Address - Zip Code:85658-4697
Practice Address - Country:US
Practice Address - Phone:520-256-6035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-15
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ306838363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner