Healthcare Provider Details

I. General information

NPI: 1740237932
Provider Name (Legal Business Name): ASHLEY K BRUCE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 10/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11130 KINGSTON PIKE SUITE 7&8
FARRAGUT TN
37934-2865
US

IV. Provider business mailing address

1225 E WEISGARBER RD SUITE 200
KNOXVILLE TN
37909-2604
US

V. Phone/Fax

Practice location:
  • Phone: 865-675-1953
  • Fax: 865-675-0877
Mailing address:
  • Phone: 865-584-4747
  • Fax: 865-584-1363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN 11640
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: