Healthcare Provider Details

I. General information

NPI: 1689299919
Provider Name (Legal Business Name): CRYSTAL B ASHLEY MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2020
Last Update Date: 01/28/2022
Certification Date: 01/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 E UNAKA AVE
JOHNSON CITY TN
37601-4626
US

IV. Provider business mailing address

1167 SPRATLIN PARK DR
GRAY TN
37615-6205
US

V. Phone/Fax

Practice location:
  • Phone: 423-926-0940
  • Fax: 423-926-4202
Mailing address:
  • Phone: 423-467-3600
  • Fax: 423-467-3644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN61160798
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number0001265612
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number27739
License Number StateTN
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP61169907
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: