Provider Demographics
NPI:1124535836
Name:ASHLEY, ALISHA NICOLE (FNP-C)
Entity Type:Individual
Prefix:
First Name:ALISHA
Middle Name:NICOLE
Last Name:ASHLEY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5261 GREENWOOD TER
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31206-4341
Mailing Address - Country:US
Mailing Address - Phone:229-483-1463
Mailing Address - Fax:
Practice Address - Street 1:201 AVERA DR
Practice Address - Street 2:
Practice Address - City:FORT VALLEY
Practice Address - State:GA
Practice Address - Zip Code:31030-5008
Practice Address - Country:US
Practice Address - Phone:478-825-3317
Practice Address - Fax:478-825-5499
Is Sole Proprietor?:No
Enumeration Date:2018-01-03
Last Update Date:2018-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN-250642363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily