Healthcare Provider Details

I. General information

NPI: 1740717727
Provider Name (Legal Business Name): ASHLEY CHANTELL MAULDIN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2017
Last Update Date: 05/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 BALLY SHANNON WAY
APEX NC
27539-6330
US

IV. Provider business mailing address

304 BALLY SHANNON WAY
APEX NC
27539-6330
US

V. Phone/Fax

Practice location:
  • Phone: 561-324-7531
  • Fax: 561-324-7531
Mailing address:
  • Phone: 561-324-7531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5009502
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: