Provider Demographics
NPI:1427446202
Name:LILIENKAMP, ASHLEY MICHELLE (NP-C)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:MICHELLE
Last Name:LILIENKAMP
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:MICHELLE
Other - Last Name:BENFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:112 N WEBB ST
Mailing Address - Street 2:
Mailing Address - City:WEBB CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64870-1916
Mailing Address - Country:US
Mailing Address - Phone:417-673-0366
Mailing Address - Fax:417-673-0093
Practice Address - Street 1:112 N WEBB ST
Practice Address - Street 2:
Practice Address - City:WEBB CITY
Practice Address - State:MO
Practice Address - Zip Code:64870-1916
Practice Address - Country:US
Practice Address - Phone:417-673-0366
Practice Address - Fax:417-673-0093
Is Sole Proprietor?:No
Enumeration Date:2015-01-02
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014044180363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily