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General NPI Number Information
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NPI Number | 1700768405
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Entity Type | Individual
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Provider Name | ASHLEY NICOLE MEDLIN LMT, MMP
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Gender | Female
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Dates
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Enumeration Date | 07/23/2025
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Last Update Date | 07/23/2025
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Provider Practice Location Address
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Address Line | 101 STATE HIGHWAY 15 S STE C
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City | NEW ALBANY
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State | MS
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Zip | 38652-5223
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Country | US
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Telephone | 662-317-1007
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Fax |
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Provider Business Mailing Address
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Address Line | 1210 COUNTY ROAD 73
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City | MYRTLE
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State | MS
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Zip | 38650-9670
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Country | US
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Telephone | 662-317-1007
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 1670
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License Number State | MS
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