Provider Demographics
NPI:1285256065
Name:SOUTHERN, ASHLEY (NMD)
Entity type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:
Last Name:SOUTHERN
Suffix:
Gender:F
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 E WILLIAMS FIELD RD STE 101
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-5231
Mailing Address - Country:US
Mailing Address - Phone:480-270-8318
Mailing Address - Fax:
Practice Address - Street 1:115 E WILLIAMS FIELD RD STE 101
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-5231
Practice Address - Country:US
Practice Address - Phone:480-270-8318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-14
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ20-1857175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty