Healthcare Provider Details

I. General information

NPI: 1356146377
Provider Name (Legal Business Name): ASHTON COLES FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2025
Last Update Date: 03/11/2025
Certification Date: 03/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 W FOREST AVE
JACKSON TN
38301-3937
US

IV. Provider business mailing address

700 W FOREST AVE
JACKSON TN
38301-3937
US

V. Phone/Fax

Practice location:
  • Phone: 731-541-9490
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0000255862
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number38404
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: