Provider Demographics
NPI:1962047878
Name:VERNON, ASHLEY M
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:M
Last Name:VERNON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3016 GROSS AVE NE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44714-1512
Mailing Address - Country:US
Mailing Address - Phone:330-412-7232
Mailing Address - Fax:
Practice Address - Street 1:3016 GROSS AVE NE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44714-1512
Practice Address - Country:US
Practice Address - Phone:330-412-7232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-14
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide