Healthcare Provider Details

I. General information

NPI: 1568769073
Provider Name (Legal Business Name): ASHELEY W COSTNER FPMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2011
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4006 HENDERSON DR
JACKSONVILLE NC
28546-0055
US

IV. Provider business mailing address

4006 HENDERSON DR
JACKSONVILLE NC
28546-0055
US

V. Phone/Fax

Practice location:
  • Phone: 910-353-6406
  • Fax:
Mailing address:
  • Phone: 910-353-6406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5005085
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: