Healthcare Provider Details

I. General information

NPI: 1457987489
Provider Name (Legal Business Name): MRS. ASHLEY RENNER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2020
Last Update Date: 10/05/2023
Certification Date: 10/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 CHURCH STREET
BERRYVILLE VA
22611
US

IV. Provider business mailing address

115 CHURCH ST
BERRYVILLE VA
22611
US

V. Phone/Fax

Practice location:
  • Phone: 540-955-4811
  • Fax: 540-955-0976
Mailing address:
  • Phone: 540-955-4811
  • Fax: 540-955-0976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024179016
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: