Healthcare Provider Details

I. General information

NPI: 1366889552
Provider Name (Legal Business Name): ASHLEY DICKSON TAYLOR CRNA, DMP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2013
Last Update Date: 01/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 S STERLING ST
MORGANTON NC
28655-4044
US

IV. Provider business mailing address

1431 CENTERPOINT BLVD SUITE 100
KNOXVILLE TN
37932-1984
US

V. Phone/Fax

Practice location:
  • Phone: 828-580-5000
  • Fax:
Mailing address:
  • Phone: 865-985-7049
  • Fax: 865-291-3228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number207783
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number77680
License Number StateWV
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number090770
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: