Healthcare Provider Details

I. General information

NPI: 1386559771
Provider Name (Legal Business Name): ASHLEY E SHORTRIDGE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

329 WESLEY ST
JOHNSON CITY TN
37601-1721
US

IV. Provider business mailing address

47 VIERS CT
LEBANON VA
24266-3953
US

V. Phone/Fax

Practice location:
  • Phone: 423-631-0055
  • Fax:
Mailing address:
  • Phone: 276-451-1037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024198410
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: