Healthcare Provider Details

I. General information

NPI: 1720336852
Provider Name (Legal Business Name): ASHLEIGH A. TWYNER RN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASHLEIGH A. WASHINGTON RN, CNP

II. Dates (important events)

Enumeration Date: 08/21/2012
Last Update Date: 09/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 N STATE ST
JACKSON MS
39216-4500
US

IV. Provider business mailing address

2500 N. STATE STREET CBO - SUITE 4200
JACKSON MS
39216-4500
US

V. Phone/Fax

Practice location:
  • Phone: 601-815-4775
  • Fax:
Mailing address:
  • Phone: 601-496-9794
  • Fax: 601-815-0434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR207116-3
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: