Healthcare Provider Details

I. General information

NPI: 1205380805
Provider Name (Legal Business Name): ASHLEY NICOLE WHITLOW NNP- BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2016
Last Update Date: 03/14/2023
Certification Date: 03/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1906 BELLEVIEW AVE SE 14 SOUTH
ROANOKE VA
24014-1838
US

IV. Provider business mailing address

481 GUILFORD CIR
MARIETTA GA
30068-3032
US

V. Phone/Fax

Practice location:
  • Phone: 540-266-6012
  • Fax:
Mailing address:
  • Phone: 276-252-4966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number0024173761
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberRN275966
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: