Healthcare Provider Details

I. General information

NPI: 1114696622
Provider Name (Legal Business Name): ASHLEY WEAR CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2021
Last Update Date: 12/20/2023
Certification Date: 12/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2111 PARKWAY OFFICE CIR STE 150
HOOVER AL
35244-2920
US

IV. Provider business mailing address

2111 PARKWAY OFFICE CIR STE 150
HOOVER AL
35244-2920
US

V. Phone/Fax

Practice location:
  • Phone: 205-364-2347
  • Fax:
Mailing address:
  • Phone: 205-364-2347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number1-159584
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1-159584
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: