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NPI Code Detail

MEDICARE: MRS. ASHLEY WISE LUTTRELL FNP

MEDICARE: MRS. ASHLEY WISE LUTTRELL FNP
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
1363L00000XNurse Practitioner17685TN
2363LF0000XFamily Nurse Practitioner17685TN

General Provider Information

NPI Number : 1124467832
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ASHLEY WISE LUTTRELL FNP
Provider Business Mailing Address
First Line : 301 PORTSMOUTH RD
Second Line :
City : KNOXVILLE
State : TN
Zip : 37909-3020
Country : US
Telephone Number : 865-274-0474
Fax Number : 865-263-8554
Provider Business Practice Location Address
First Line : 2330 S LAMAR BLVD
Second Line :
City : AUSTIN
State : TX
Zip : 78704-5264
Country : US
Telephone Number : 888-828-5881
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/17/2013
Last Update Date : 09/03/2024

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