Healthcare Provider Details

I. General information

NPI: 1346768165
Provider Name (Legal Business Name): ASHLEY WALLER STARNES FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2017
Last Update Date: 05/27/2021
Certification Date: 05/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

631 COX RD
GASTONIA NC
28054-3438
US

IV. Provider business mailing address

808 SCHENCK ST
SHELBY NC
28150-3934
US

V. Phone/Fax

Practice location:
  • Phone: 48-647-7647
  • Fax: 704-867-7894
Mailing address:
  • Phone: 704-480-9344
  • Fax: 704-484-3260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5009841
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number233075
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: