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NPI Code Detail

MEDICARE: ASHLEY PHELPS FNP-BC

MEDICARE: ASHLEY PHELPS FNP-BC
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
1363LF0000XFamily Nurse Practitioner21157TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12015010039OTHERTNANCC
221157OTHERTNFNP

General Provider Information

NPI Number : 1255782025
Entity Type Code : Individual
Provider Name (Legal Business Name) : ASHLEY PHELPS FNP-BC
Provider Business Mailing Address
First Line : 1119 E COLLEGE ST
Second Line : STE 1
City : PULASKI
State : TN
Zip : 38478-4563
Country : US
Telephone Number : 931-207-8630
Fax Number : 931-207-8629
Provider Business Practice Location Address
First Line : 1119 E COLLEGE ST
Second Line : STE 1
City : PULASKI
State : TN
Zip : 38478-4563
Country : US
Telephone Number : 931-207-8630
Fax Number : 931-207-8629
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/23/2016
Last Update Date : 06/23/2016

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Directions to “ ASHLEY PHELPS FNP-BC” Practice Location

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