Healthcare Provider Details

I. General information

NPI: 1972921971
Provider Name (Legal Business Name): ASHLEY ELIZABETH ROACH FNP-C, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2014
Last Update Date: 02/10/2026
Certification Date: 02/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6890 W ANDREW JOHNSON HWY
TALBOTT TN
37877-8610
US

IV. Provider business mailing address

6890 W ANDREW JOHNSON HWY
TALBOTT TN
37877-8610
US

V. Phone/Fax

Practice location:
  • Phone: 423-839-2120
  • Fax: 423-839-2125
Mailing address:
  • Phone: 423-839-2120
  • Fax: 423-839-2125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number37816
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN0000160323
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: