Healthcare Provider Details

I. General information

NPI: 1023323201
Provider Name (Legal Business Name): ASHLEY NICOLE UNDERWOOD FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2010
Last Update Date: 08/12/2022
Certification Date: 08/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

199 HOSPITAL DR
GALAX VA
24333-2454
US

IV. Provider business mailing address

213 S JEFFERSON ST STE 1006
ROANOKE VA
24011-1713
US

V. Phone/Fax

Practice location:
  • Phone: 276-236-5181
  • Fax: 276-236-3297
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024168867
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: