Provider Demographics
NPI:1508596776
Name:MANGRUM, ASHLEY ANN (RN)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:ANN
Last Name:MANGRUM
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4622 LINWOOD RD
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37184-4917
Mailing Address - Country:US
Mailing Address - Phone:615-879-9775
Mailing Address - Fax:
Practice Address - Street 1:4622 LINWOOD RD
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:TN
Practice Address - Zip Code:37184-4917
Practice Address - Country:US
Practice Address - Phone:615-879-9775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-12
Last Update Date:2022-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000155156163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse