Healthcare Provider Details

I. General information

NPI: 1649644055
Provider Name (Legal Business Name): ASHLEY P STIDHAM NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASHLEY M PANNELL

II. Dates (important events)

Enumeration Date: 11/23/2015
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

271 MEDICAL PARK BLVD
BRISTOL TN
37620-7455
US

IV. Provider business mailing address

1021 W OAKLAND AVE STE 310
JOHNSON CITY TN
37604-2192
US

V. Phone/Fax

Practice location:
  • Phone: 423-274-8600
  • Fax:
Mailing address:
  • Phone: 423-952-2111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024195027
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number20368
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: