Healthcare Provider Details

I. General information

NPI: 1578234951
Provider Name (Legal Business Name): ASHLEY LOREN BRYANT CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASHLEY LOREN CHISLOM CRNP

II. Dates (important events)

Enumeration Date: 09/24/2021
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2173 NORMANDIE DR
MONTGOMERY AL
36111-2728
US

IV. Provider business mailing address

PO BOX 370
FORTSON GA
31808-0370
US

V. Phone/Fax

Practice location:
  • Phone: 334-438-2642
  • Fax:
Mailing address:
  • Phone: 706-494-3171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-145925
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: