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General NPI Number Information
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NPI Number | 1033008180
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Entity Type | Individual
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Provider Name | ASHLEY TIERRA WALLER MSN, APRN, PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 07/02/2025
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Last Update Date | 09/17/2026
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Provider Practice Location Address
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Address Line | 3633 WHEELER RD STE 365
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City | AUGUSTA
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State | GA
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Zip | 30909-6549
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Country | US
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Telephone | 706-432-6866
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Fax |
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Provider Business Mailing Address
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Address Line | 209 W HAVEN DR
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City | KATHLEEN
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State | GA
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Zip | 31047-3122
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Country | US
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Telephone | 478-508-5523
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APRN-NP286520
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 163WM0705X
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Taxonomy Name | Medical-Surgical Registered Nurse
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License Number | RN286520
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License Number State | GA
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