Healthcare Provider Details

I. General information

NPI: 1083447189
Provider Name (Legal Business Name): ASHLEY NICOLE ALLEN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2024
Last Update Date: 12/23/2025
Certification Date: 12/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 S GREENE ST
BALTIMORE MD
21201-1544
US

IV. Provider business mailing address

9543 DUBLIN RD
WALKERSVILLE MD
21793-8608
US

V. Phone/Fax

Practice location:
  • Phone: 443-386-9883
  • Fax:
Mailing address:
  • Phone: 443-386-9883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR224864
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR224864
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: