=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912685249
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ASHLEY MARIE EASTERLING RN,MSN,APRN,PMHNP-BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/07/2023
-----------------------------------------------------
Last Update Date | 09/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2251 MAGNOLIA ST UNIT 82
-----------------------------------------------------
City | ORANGEBURG
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29115-3635
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-960-6628
-----------------------------------------------------
Fax | 803-960-6628
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3534 VANCE RD
-----------------------------------------------------
City | HOLLY HILL
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29059-9128
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-970-6628
-----------------------------------------------------
Fax | 803-970-6628
-----------------------------------------------------
=====================================================
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 | 30684
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------