Healthcare Provider Details

I. General information

NPI: 1629207071
Provider Name (Legal Business Name): ASHLEY PHILLIPS THURMAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2009
Last Update Date: 01/25/2022
Certification Date: 01/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

485 N CHANCERY ST STE B
MCMINNVILLE TN
37110-2005
US

IV. Provider business mailing address

820 SPRINGER DR
LOMBARD IL
60148-6413
US

V. Phone/Fax

Practice location:
  • Phone: 931-304-8585
  • Fax:
Mailing address:
  • Phone: 815-744-8554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number14254
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: