Provider Demographics
NPI:1588919591
Name:REESE, ASHLEY GRACE (PA-C)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:GRACE
Last Name:REESE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1671
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21501-1671
Mailing Address - Country:US
Mailing Address - Phone:304-726-4501
Mailing Address - Fax:
Practice Address - Street 1:45 HUNT CLUB DR
Practice Address - Street 2:
Practice Address - City:RIDGELEY
Practice Address - State:WV
Practice Address - Zip Code:26753-7567
Practice Address - Country:US
Practice Address - Phone:304-726-4501
Practice Address - Fax:304-726-4051
Is Sole Proprietor?:No
Enumeration Date:2012-07-16
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC05705363A00000X
WV2174363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant