Provider Demographics
NPI:1851986822
Name:EASTMAN, ASHLEY A (NP)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:A
Last Name:EASTMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 N WACO ST STE 220
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67202-1102
Mailing Address - Country:US
Mailing Address - Phone:316-722-2138
Mailing Address - Fax:833-464-2530
Practice Address - Street 1:245 N WACO ST STE 220
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67202-1102
Practice Address - Country:US
Practice Address - Phone:316-722-2138
Practice Address - Fax:833-464-2530
Is Sole Proprietor?:No
Enumeration Date:2021-03-02
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSW11140163WW0000X
KS5380044062363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WW0000XNursing Service ProvidersRegistered NurseWound Care