MEDICARE: ASHLEY LAINE ANDERSON 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
1	363L00000X	Nurse Practitioner	149538	TN
2	363LF0000X	Family Nurse Practitioner	0000012721	TN

General Provider Information

NPI Number	:	1487870077
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY LAINE ANDERSON FNP

Provider Business Mailing Address
First Line	:	228 PARK AVE S STE 16389
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10003-1502
Country	:	US
Telephone Number	:	646-876-8455
Fax Number	:	833-314-0246

Provider Business Practice Location Address
First Line	:	228 PARK AVE S
Second Line	:	STE 16389
City	:	NEW YORK
State	:	NY
Zip	:	10003-1502
Country	:	US
Telephone Number	:	646-876-8455
Fax Number	:	833-314-0246

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

Provider Enumeration Date	:	04/18/2007
Last Update Date	:	09/26/2023

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