Healthcare Provider Details

I. General information

NPI: 1972873750
Provider Name (Legal Business Name): ASHLEY FENTON CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2012
Last Update Date: 03/24/2023
Certification Date: 03/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1404 S MAIN CHAPEL WAY STE 104
GAMBRILLS MD
21054-1860
US

IV. Provider business mailing address

1404 S MAIN CHAPEL WAY STE 104
GAMBRILLS MD
21054-1860
US

V. Phone/Fax

Practice location:
  • Phone: 484-494-8924
  • Fax:
Mailing address:
  • Phone: 443-494-8924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR214660
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR214660
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: