Healthcare Provider Details

I. General information

NPI: 1437950961
Provider Name (Legal Business Name): ASHLEY MARIE KEYLON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASHLEY MARIE MCINTURFF

II. Dates (important events)

Enumeration Date: 03/21/2025
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 E MAIN BLVD
CHURCH HILL TN
37642-3312
US

IV. Provider business mailing address

2560 BRIDGEFORTH XING
KINGSPORT TN
37664-5785
US

V. Phone/Fax

Practice location:
  • Phone: 423-256-2196
  • Fax:
Mailing address:
  • Phone: 423-440-9538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number38439
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number38439
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: