Healthcare Provider Details

I. General information

NPI: 1164840021
Provider Name (Legal Business Name): ASHLEY TALLON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2014
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 STEEL MILL RD
DARLINGTON SC
29540-8759
US

IV. Provider business mailing address

300 STEEL MILL RD
DARLINGTON SC
29540-8759
US

V. Phone/Fax

Practice location:
  • Phone: 843-395-8613
  • Fax: 877-724-9204
Mailing address:
  • Phone: 843-395-8613
  • Fax: 877-724-9204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number22952
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: