Provider Demographics
NPI:1356682215
Name:DEBERRY, ASHLEY DANIELLE (NNP-BC)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:DANIELLE
Last Name:DEBERRY
Suffix:
Gender:F
Credentials:NNP-BC
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:DANIELLE
Other - Last Name:MOORE-MATHIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 658
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30503-0658
Mailing Address - Country:US
Mailing Address - Phone:770-533-6511
Mailing Address - Fax:770-533-4786
Practice Address - Street 1:743 SPRING ST NE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501
Practice Address - Country:US
Practice Address - Phone:770-535-3611
Practice Address - Fax:770-535-7052
Is Sole Proprietor?:No
Enumeration Date:2013-03-01
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP136660363LN0000X
GARN152548363LN0005X
MI4704358519363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
No363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care