Individual
ASHLEY MARIE CLARK MEDINA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3010 TRENWEST DR, WINSTON SALEM, NC 27103-3208
(336) 970-5300
(336) 970-6334
Mailing address
PO BOX 96822, CHARLOTTE, NC 28296-6822
(800) 889-4447
Taxonomy
Speciality
Code
Description
License number
State
2085R0204X
Vascular & Interventional Radiology Physician
0010-04099
NC
363A00000X
Physician Assistant
Primary
0010-04099
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
133176
—
AL
05
—
1720372790
—
NC
01
—
188P0
BCBS
NC
05
—
30018289480001
—
VA
01
—
Y08KY
BLUE CROSS BLUE SHIELD
FL
Enumeration date
06/07/2011
Last updated
08/20/2025
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