=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740147941
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ASHTON MICHELLE AZEVEDO PMHNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/08/2026
-----------------------------------------------------
Last Update Date | 01/08/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1186 S US HIGHWAY 45 BYP
-----------------------------------------------------
City | JACKSON
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38301-3256
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 731-215-0502
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 235 MCADAMS LOOP
-----------------------------------------------------
City | JACKS CREEK
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38347-1789
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 731-879-0683
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | 254994
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------