MEDICARE: ASHLEY ROSSER WOOTEN 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
1	363LF0000X	Family Nurse Practitioner	17535	SC

General Provider Information

NPI Number	:	1912294562
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY ROSSER WOOTEN FNP-BC

Provider Business Mailing Address
First Line	:	86 VILLA RD
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29615-3052
Country	:	US
Telephone Number	:	864-334-8979
Fax Number	:	833-794-1844

Provider Business Practice Location Address
First Line	:	86 VILLA RD
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29615-3052
Country	:	US
Telephone Number	:	864-334-8979
Fax Number	:	833-794-1844

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

Provider Enumeration Date	:	07/05/2011
Last Update Date	:	01/23/2024

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