Healthcare Provider Details

I. General information

NPI: 1053298240
Provider Name (Legal Business Name): ASHLEY MARTIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2025
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1745 COUNTY ROAD 116
TOWN CREEK AL
35672-7251
US

IV. Provider business mailing address

1745 COUNTY ROAD 116
TOWN CREEK AL
35672-7251
US

V. Phone/Fax

Practice location:
  • Phone: 256-565-0935
  • Fax:
Mailing address:
  • Phone: 256-565-0935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number1-113679
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: