Individual
ASHLEY KEOHAVONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1260 ELM ST, MANCHESTER, NH 03101-1305
(603) 314-1701
Mailing address
1260 ELM ST, MANCHESTER, NH 03101-1305
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
1243515
—
363AS0400X
Surgical Physician Assistant
1243515
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
01/18/2025
Last updated
03/25/2026
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