Provider Demographics
NPI:1255688784
Name:BROWN, ASHLEY ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:ANN
Last Name:BROWN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1446
Mailing Address - Street 2:
Mailing Address - City:DYERSBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38025-1446
Mailing Address - Country:US
Mailing Address - Phone:731-427-9971
Mailing Address - Fax:731-427-8624
Practice Address - Street 1:28 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301-3947
Practice Address - Country:US
Practice Address - Phone:731-427-9971
Practice Address - Fax:731-427-8624
Is Sole Proprietor?:No
Enumeration Date:2012-08-15
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2174363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant