Provider Demographics
NPI:1427080381
Name:ASHLEY, BECKY LYNN (MD)
Entity type:Individual
Prefix:
First Name:BECKY
Middle Name:LYNN
Last Name:ASHLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 JENSON STREET
Mailing Address - Street 2:
Mailing Address - City:GAYLORD
Mailing Address - State:MI
Mailing Address - Zip Code:49735
Mailing Address - Country:US
Mailing Address - Phone:989-732-4422
Mailing Address - Fax:989-732-4402
Practice Address - Street 1:101 JENSON STREET
Practice Address - Street 2:
Practice Address - City:GAYLORD
Practice Address - State:MI
Practice Address - Zip Code:49735
Practice Address - Country:US
Practice Address - Phone:989-732-4422
Practice Address - Fax:989-732-4402
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301074107207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4416628Medicaid
0F96004012Medicare ID - Type UnspecifiedPROVIDER NUMBER
MI4416628Medicaid