=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265022776
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ASHLEIGH BROOKE WARREN FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/20/2021
-----------------------------------------------------
Last Update Date | 12/08/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3521 GRAYSTONE PL SE STE 202
-----------------------------------------------------
City | CONOVER
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28613-8269
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-732-5700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1504 2ND ST NE
-----------------------------------------------------
City | HICKORY
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28601-2551
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-322-3037
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 5013994
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------