Healthcare Provider Details

I. General information

NPI: 1639891237
Provider Name (Legal Business Name): ASHLY C YOUNT FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2022
Last Update Date: 10/01/2024
Certification Date: 10/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3815 HIGHWAY 66 S STE 1
ROGERSVILLE TN
37857-5197
US

IV. Provider business mailing address

3815 HIGHWAY 66 S STE 1
ROGERSVILLE TN
37857-5197
US

V. Phone/Fax

Practice location:
  • Phone: 423-817-3542
  • Fax: 423-717-5562
Mailing address:
  • Phone: 423-817-3542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number32402
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: