Healthcare Provider Details

I. General information

NPI: 1275048894
Provider Name (Legal Business Name): ASHTON HAYNES KELLEY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2017
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 MAGNOLIA ST
GREENSBORO NC
27401-1309
US

IV. Provider business mailing address

1220 MAGNOLIA ST
GREENSBORO NC
27401-1309
US

V. Phone/Fax

Practice location:
  • Phone: 336-938-0800
  • Fax: 336-938-0755
Mailing address:
  • Phone: 336-938-0800
  • Fax: 336-938-0755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2021039843
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5010090
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA005241
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: