Healthcare Provider Details

I. General information

NPI: 1912740234
Provider Name (Legal Business Name): ASHLEY MICHELLE FULLER APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ASHLEY MICHELLE JONES

II. Dates (important events)

Enumeration Date: 06/14/2024
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 MEADOWVIEW PKWY
KINGSPORT TN
37660-7475
US

IV. Provider business mailing address

1021 W OAKLAND AVE STE 310
JOHNSON CITY TN
37604-2192
US

V. Phone/Fax

Practice location:
  • Phone: 423-230-5000
  • Fax:
Mailing address:
  • Phone: 423-952-2111
  • Fax: 423-282-1657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number36489
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024194939
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: