Provider Demographics
NPI:1497372015
Name:SLOAN, ASHLEY (NP-C)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:SLOAN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 ADAIR ST
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047-9617
Mailing Address - Country:US
Mailing Address - Phone:601-910-9688
Mailing Address - Fax:
Practice Address - Street 1:1710 OLD FANNIN RD
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-9004
Practice Address - Country:US
Practice Address - Phone:601-487-9191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-30
Last Update Date:2020-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS903817363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner