Provider Demographics
NPI:1285983973
Name:DISNEY, ASHLEY LYNN (PA-C)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:LYNN
Last Name:DISNEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:ASHLEY
Other - Middle Name:LYNN
Other - Last Name:ELIASON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:181 INTERSTATE PARKWAY
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:PA
Mailing Address - Zip Code:16701
Mailing Address - Country:US
Mailing Address - Phone:814-362-4345
Mailing Address - Fax:814-362-1178
Practice Address - Street 1:181 INTERSTATE PARKWAY
Practice Address - Street 2:
Practice Address - City:BRADFORD
Practice Address - State:PA
Practice Address - Zip Code:16701
Practice Address - Country:US
Practice Address - Phone:814-362-4345
Practice Address - Fax:814-362-1178
Is Sole Proprietor?:No
Enumeration Date:2012-09-10
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA055914363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical