MEDICARE: ASHLEY MICHELE WILTCHER AGPCNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LG0600X	Gerontology Nurse Practitioner	5015372	NC
2	364SG0600X	Gerontology Clinical Nurse Specialist	AP09060	LA
3	363LG0600X	Gerontology Nurse Practitioner	AP09060	LA
4	363LF0000X	Family Nurse Practitioner	AP09060	LA
5	363LA2200X	Adult Health Nurse Practitioner	5015372	NC
6	363L00000X	Nurse Practitioner	5015372	NC

General Provider Information

NPI Number	:	1043762719
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY MICHELE WILTCHER AGPCNP

Provider Business Mailing Address
First Line	:	1030 COULWOOD LN
Second Line	:
City	:	INDIAN TRAIL
State	:	NC
Zip	:	28079-4347
Country	:	US
Telephone Number	:	318-732-5187
Fax Number	:

Provider Business Practice Location Address
First Line	:	1030 COULWOOD LN
Second Line	:
City	:	INDIAN TRAIL
State	:	NC
Zip	:	28079-4347
Country	:	US
Telephone Number	:	318-732-5187
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/28/2016
Last Update Date	:	04/20/2026

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