Healthcare Provider Details

I. General information

NPI: 1215487905
Provider Name (Legal Business Name): ASHLEY ANDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2016
Last Update Date: 02/01/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 19TH ST S LHRB 509
BIRMINGHAM AL
35233-1926
US

IV. Provider business mailing address

1780 CHACE DR
HOOVER AL
35244-3708
US

V. Phone/Fax

Practice location:
  • Phone: 205-996-0882
  • Fax:
Mailing address:
  • Phone: 256-762-7544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number1-143722
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number1-143722
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: