Healthcare Provider Details

I. General information

NPI: 1073641031
Provider Name (Legal Business Name): ASHLEY COWART CARSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 06/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 E WENDOVER AVE
GREENSBORO NC
27405-6713
US

IV. Provider business mailing address

8 FOXFIRE CT
GREENSBORO NC
27410-3246
US

V. Phone/Fax

Practice location:
  • Phone: 336-641-7777
  • Fax:
Mailing address:
  • Phone: 336-641-3245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number22344
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number126010
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: