Provider Demographics
NPI:1336983543
Name:SEPULVADO, ASHLEY RAEL (FNP-C)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:RAEL
Last Name:SEPULVADO
Suffix:
Gender:
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 BERT KOUNS INDUSTRIAL LOOP STE A
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71118-3351
Mailing Address - Country:US
Mailing Address - Phone:318-496-3302
Mailing Address - Fax:866-554-1968
Practice Address - Street 1:395 S CAPITOL ST
Practice Address - Street 2:
Practice Address - City:MANY
Practice Address - State:LA
Practice Address - Zip Code:71449-3049
Practice Address - Country:US
Practice Address - Phone:318-256-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-21
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA208332363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily